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Smoking Cessation Counseling 99406 bundling with Vaccine Admin - 90471

P

pakalis

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6
Location
Holyoke, MA
We have billed a 99213-25, 99406, 90471 and 90732.
The payer has denied 99406 (smoking counseling code) stating that it is bundled to 90471 (vaccine admin code). Stating due to NCCI. I can't locate any NCCI information with regards to smoking cessation, as it is an e/m code perhaps we should have added a 25 modifier to the 99406 as well as the 99213 in order to unbundle?
The DX linkage is correct in that the 99406 is linked to 305.1 - tobacco disorder and 90471 to V03.82 - need for pneumococcal vaccine.

Thanks in advance to anyone who can help.

Paula
 
Paula- Code 99406 is for Tobacco cessation-counseling with a tobacco-related illness. The Primary Dx code needs to be of that illness, i.e. COPD, and then the Tobacco Use Disorder (305.1) or Personal History of Tobacco Use (V15.82) as appropriate as the Secondary code.

If the patient is Asymptomatic, then G0436 (3-10 min) or G0437 (>10 min) are the codes to use. Dx of 305.1 or V15.82 as the case may be.

Hope that helps some,
Glenn
 
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