Pulmonology Coding Alert

Question: My pulmonologist wants me to make sure we are capturing the time he spends on individual smoking cessation counseling, but I have received a few denials for the HCPCS code (S9075) I am using. Would I have better luck using the CPT codes (99401-99404)?

Montana Subscriber

Answer: Since no global rules exist for reporting smoking cessation, achieving reimbursement for these services can be tricky. Further complicating the matter is the fact that many private payers prefer standard CPT codes rather than HCPCS codes, while some still accept the latter.

If a patient does not have a smoking-related illness or disease that made him a candidate for a cessation program, consider billing 99401-99404 (Preventive medicine counseling and/or risk factor reduction intervention[s] ...).

If the patient is a Medicare beneficiary and has a smoking-related illness, disease, or symptom, you can capture various counseling lengths in light of the established condition or symptom. For smoking-cessation counseling the pulmonologist provides to an individual, Medicare accepts two CPT codes:

" 99406 -- Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes

" 99407 -- ... intensive, greater than 10 minutes.

Medicare allows you to bill for two counseling attempts every 12 months. Each attempt includes up to four intermediate or intensive sessions, for a total of eight possible 99406-99407 visits in a year.

Reporting HCPCS code S9075 (Smoking cessation treatment) is typically reserved for private payers who have contractually arranged for treatment sessions with a provider. Before reporting this S code, keep in mind that it has restricted use requirements.