Wiki Oncology E&M MDM Credit for Cigarette abuse?

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mbuckner

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I am questioning if I can give credit for , "cigarette abuse" in my medical decision making for E&M level of service. The patient has Lung cancer and Cigarette abuse is listed in the A/P but no smoking cessation counseling was done.
example:
Assessment/plan
1. Lung Cancer. We will continue afatinib and reassess in two weeks
2. Cigarette abuse, ongoing.
3. fatigue, ongoing, without nutritional deficiency
4. CINV. I have renewed his prescription for Phenergan. We will monitor. Liberal fluids advised.

Thanks!
 
What exactly do you mean by "give credit?"

If the smoking is not addressed in any way during the encounter, you would not be able to get # of dx/mgmt credit for it. However, the fact that the pt continues to smoke does probably impact the overall management/tx of the lung cancer diagnosis.

Counseling for smoking cessation does not typically impact the actual office visit charge. There are CPT/HCPCS codes specific to smoking cessation counseling that should be used for this service.
 
It will be questionable and an auditor could argue that with no plan and no counseling it is only an active problem not being addressed at the episode of care. Perhaps listing a V code for smoking (V15.82) vs tobacco abuse (305.1) would be a better way to report it. For the MDM credit though your documentation will need to be stronger to demonstrate it was addressed at this episode of care.
 
Thanks for the replies. As far as giving credit, the number of diagnosis is a factor in determining the E/M level of service. Normally our patients are seen for Cancer diagnosis and the "cigarette abuse" is a condition that may play a factor in the primary diagnosis and treatment. The physicians don't normally do counseling on the abuse diagnosis.

Another example: 1. Cigarette abuse, ongoing. Encouraged to stop.

How would this need to be worded in order for it to be a factor in the MDM for determining the level of service?
 
An ongoing problem gets you 1 #of diagnosis point. Since your specialty is oncology, is this on a treatment day (infusion/injection..)?

If it is, and "encouraged to stop" is the intervention, this diagnosis alone would not be significant enough to support a separately billed E/M or increase the level of service being billed if other assessments are involved.

The CMS MLN Matters on smoking cessation counseling is MM7133.
 
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