Pulmonology Coding Alert

Question: I have a physician’s report that indicates they spent time with the patient discussing smoking cessation. Does the time documented in the report need to be specific or can it be a range of time to code the discussion? Also, is anything else required for the documentation of smoking cessation?

Idaho Subscriber

Answer: For smoking cessation claims, payers expect a notation of the specific time rather than the range associated with the CPT^® descriptor. If the documentation includes the amount of time for the discussion, such as “the physician spent 10 minutes counseling the patient,” then that documentation will back up the CPT^® code and descriptor.

 To capture the conversation with the patient, you will use 99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) or, if the provider spent more than 10 minutes counseling the patient, then you’ll use 99407 (…; intensive, greater than 10 minutes). The counseling codes are time based, so 99406 will only apply to time spent between three and 10 minutes, but once the time spent with the patient exceeds 10 minutes, you will report one unit of 99407 regardless of the total length of time.

Additionally, you should select a specific code from the F17.- (Nicotine dependence) and T65.2- (Toxic effect of tobacco and nicotine) code sets depending on what the physician called out in their report.

For example, if the patient has nicotine dependence and is experiencing symptoms related to the toxic effect of smoking like shortness of breath, you will code the report as T65.222- (Toxic effect of tobacco cigarettes, intentional self-harm) as well as F17.- to show the patient is nicotine dependent and suffering from the toxic effects of smoking intentionally.

Lastly, you should include what the physician discussed with the patient, cessation options offered, and if the physician supplied the patient with any literature in the report.