Pulmonology Coding Alert

Question: Do I still need a plan and referral to support smoking cessation counseling? What, if any, are the limits on how often we can bill for this service? North Carolina Subscriber Answer: CMS does not include an action plan and referral as part of its national requirements for reporting smoking counseling cessation. While such may be the clinical goal for patient care, the physician must discuss all available options only for the patient to select. The service may simply end after the discussion if the patient shows no interest in initiating a mutually agreed upon plan. The Medicare National Coverage Determinations Manual (Section 210.4) and Medicare Claims Processing Manual (Chapter 32, Section 12.6, "Post-Payment Review for Smoking and Tobacco-Use Cessation Counseling Services") do not require that covered counseling must include a plan for the patient to quit, and a referral to a treatment center. Take note: Section 12.6 of [...]