Pulmonology Coding Alert

Erase the smoking cessation G-codes from your code list this year.

Did you miss this important HCPCS update for reporting smoking cessation services for asymptomatic smokers that came in this last quarter of the year? Here’s a quick run through of the changes, and the codes to avoid.

Don’t overlook: CMS deleted HCPCS Level-II codes G0436 (Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes) and G0437 (Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes) effective Sept. 30, 2016. Don’t make the mistake of reporting these outdated codes anymore.

CMS most likely deleted these codes to promote “consistency of reporting, and the task force recommendations for this service to be offered to all patients, regardless of their current state of health,” says Carol Pohlig, BSN, RN, CPC, ACS, senior coding andeducation specialist at the Hospital of the University of Pennsylvania.

As of Oct. 1, 2016, you should report CPT^® codes 99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) and 99407 (Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes) for your smoking cessation counseling claims.

Background: The discontinued G codes reported smoking cessation counseling provided to patients who did not exhibit any signs or symptoms of a tobacco related disease. These G codes were introduced in 2011, and the Accountable Care Act (ACA) provided for a waiver of Medicare coinsurance and Part B deductible requirements for them.

Preexisting CPT^® codes 99406 and 99407 report services that a physician or a qualified health care professional provides for the purpose of promoting health and preventing illness or injury. They are distinct from evaluation and management (E/M) services in that you may report them separately with modifier 25 (Significant, separately identifiable evaluation and management [E/M] service by the same physician on the day of a procedure). In fact, you may use these codes for risk factor reduction services for patients without a specific illness when the counseling is a part of treatment.

You’ll report CPT^® codes 99406 and 99407 for smoking cessation services provided to patients who use tobacco, regardless of whether they exhibit signs or symptoms of tobacco-related disease. However, for you to report the service, you must ensure that:

• The patient is competent and alert at the time of counseling.
• A qualified physician or other Medicare-recognized practitioner furnishes the counseling.
• The frequency is two cessation attempts per year. Each attempt may include a maximum of four intermediate or intensive sessions, with the total annual benefit covering up to eight sessions per year Medicare beneficiary.

Bonus: Medicare waives the copayment/coinsurance as well as the deductibles when you report 99406 or 99407,

The next step: When reporting the counseling session, here are a list of the ICD-10-CM diagnosis codes to choose from:

• F17.200 (Nicotine dependence, unspecified, uncomplicated)
• F17.201 (…unspecified, in remission)
• F17.210 (… cigarettes, uncomplicated)
• F17.211 (… cigarettes, in remission)
• F17.220 (… chewing tobacco, uncomplicated)
• F17.221 (… chewing tobacco, in remission)
• F17.290 (…other tobacco product, uncomplicated)
• F17.291 (…other tobacco product, in remission)
• T65.211A (Toxic effect of chewing tobacco, accidental [unintentional], initial encounter)
• T65.212A (…intentional self harm…)
• T65.213A (…assault,…)
• T65.214A (…undetermined)
• T65.221A (Toxic effect of tobacco cigarettes, accidental [unintentional], initial encounter)
• T65.222A (…intentional self harm,…)
• T65.223A (…assault,…)
• T65.224A (…undetermined)
• T65.291A (Toxic effect of other tobacco and nicotine, accidental [unintentional], initial encounter)
• T65.292A (…intentional self harm,…)
• T65.293A (…assault,…)
• T65.294A (…undetermined)
• Z87.891 (Personal history of tobacco dependence).

Final takeaway: “While the inconsistent method of reporting smoking cessation counseling has been eliminated, the documentation requirements have not subsided,” Pohlig says. “Reporting smoking cessation will depend upon the documented length of time spent at each session as well as the details of counseling. Just like any other time-based service, [providers should] quantify how many minutes were spent, and stay away from generalizations, such as, ‘a lengthy discussion’ or ‘several minutes.’ Identify the methods of quitting offered to the patient, or the details surrounding the health impact smoking has on the patient’s current condition in order to substantiate the content of counseling as well as the patient’s readiness to quit. Without these items, you may not report the service.”

For more details refer to https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9768.pdf.