Wiki Unwanted Tobacco Cessation Counseling

[SUEV]

Happy New Year everyone!
If a patient is not interested in quitting but the provider counsels the patient on the risks,treatments, etc., would 99406 still be billed? The patient will get some type of bill so I would assume one of the requirements for using this code is for the patient to request it, but am I wrong?
Thanks,
Sue

 

[JDACPC]

You should check some of your major carriers as to the requirements for billing and co-pays attached (some carriers may require some type of tobacco-related illness in order to cover the service). There are also frequency limitations in place. We can't assume every patient counseled will quit on the first try, or even willingly, so my thought is this could be billed even if the patient is not yet ready to quit.

If the carriers do not cover it and the patients complain about a co-pay, decide whether it's worth the bottom line to bill the code or just roll it into the E/M service.

 

[LLovett]

I would advise against billing it

The provider is covered from a quality perspective since they documented they advised the patient to quit. If the patient says they have not intention of quitting then that should be the end of it.

I have heard in the past patients complaining to Medicare about these services being performed against their wishes, Medicare sided with the patients.

Think of it in terms of getting the oil changed in your car. You presented for a specific service, they are more often than not going to try and sell you additional services. Maybe you need a new air filter. They ask you, you tell them no, I don't want a new air filter. When the service is complete and you go to pay there is a charge for the air filter you refused in addition to the oil change. Not cool, not cool at all. I wouldn't pay for it, I would throw a fit, I would complain, I would never go back, and I would advise others not go there as well.

Food for thought,

Laura, CPC, CPMA, CEMC

 

[SUEV]

The oil change scenario is a great way to explain to the provider why these counselings may or may not be billable. As the patient is a self-pay he would definitely be stuck with the bill and then we'd be responsible for explaining to him why we charged him for something he didn't want done. Thank you both for your opinions!