Pulmonology Coding Alert

Question: Our nurse practitioner performed smoking cessation counseling on a patient who is not yet showing signs of COPD or emphysema, just to ensure he knew the risks of continuing to smoke and trying to help him stop. Our physician said we can’t report 99406 for this if the patient doesn’t have a smoking-related condition. Is this true?

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Answer: No. CMS covers smoking and tobacco use cessation counseling for outpatient and hospitalized Medicare beneficiaries who use tobacco, regardless of whether they have signs or symptoms of tobacco-related disease.

When the advanced practice provider (APP) performs the service, you may report 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 smoking cessation counseling for the APP in conjunction with the physician’s service under Medicare Part B. Only the physician or other qualified healthcare professional recognized by Medicare can bill Medicare directly for the service.

If your practitioner provides minimal counseling, say three minutes or less, along with the evaluation and management (E/M) visit, it’s covered within the E/M service and not reported separately. If the NPP furnishes the smoking cessation counseling services for more than three minutes on the same day as a scheduled office visit, you may append modifier 25 to the E/M code to indicate that the E/M service is a separately identifiable service from smoking cessation counseling, e.g., 99213-25 under the physician plus 99406 under the NPP.

Medicare covers two individual smoking cessation counseling attempts per year. Each attempt may include a maximum of four intermediate OR intensive sessions, with the total benefit covering up to eight sessions in a 12-month period.