Pulmonology Coding Alert

Question: Sometimes we fret over the difficulty of getting paid for the numerous nonphysician counseling services our practice provides. I heard we'll have new smoking-cessation codes and won't have to report 99401-99404, 99411-99412, or 96150-96155. Is that true?

Florida Subscriber

Answer: Yes. As of Jan. 1, you'll use 99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) and 99407 (... intensive, greater than 10 minutes) when your pulmonologist provides smoking-cessation counseling. Notice: The new codes are time-based. You'll use these two new codes rather than the generic counseling and/or risk factor reduction intervention codes (99401-99404, 99411-99412) for patients with no symptoms or established illness, or health and behavior assessment/intervention codes (96150-96155) for patients with disease-related problems.

Also, you should use the new codes rather than Medicare's G0375 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) and G0376 (... intensive, greater than 10 minutes), which CPT converted into the new codes.

Example: A 21-year-old with worsening asthma visits the nurse for smoking-cessation assessment and returns in one month for intervention, beginning a cessation program. In 2008, if a payer doesn't cover 96150 (Health and behavior assessment [e.g., health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires], each 15 minutes face-to-face with the patient; initial assessment) and 96152 (Health and behavior intervention, each 15 minutes, face-to-face; individual) for this encounter, you could use a smoking-cessation counseling code based on time.

Potential payer problem: Insurers that do not cover this service will expect the patient to pay for it. Many patients do not realize this until they receive a bill for services. So you should brush up on payer policy before providing a patient with 96150 service -- and let the patient know if his insurance won't cover it.