Coding & Compliance - December 2010
“Medicare to Cover Tobacco Cessation Counseling”
CMS announced several months ago that under new coverage, any smoker covered by medicare will be able to receive tobacco cessation counseling from a qualified physician or other Medicare-recognized practitioner who can work with them to help stop using tobacco.
CPT codes for tobacco cessation counseling:
- 99406 - smoking and tobacco use cessation counseling visit, intermediate, greater than 3 minutes up to 10 minutes
- 99407 - intensive, greater than 10 minutes
The physician's document "must" include the amount of time spent regarding the tobacco cessation counseling, in addition to what the counseling consisted of:
- Advising the patient to quit smoking
- Determining the patient's willingness to stop smoking
- Reviewing the risks of smoking
- Assisting the patient with quitting
- Follow-up visits
Diagnosis code(s) should reflect the condition the patient has that is affected by tobacco use, or the condition the patient is being treated for. (i.e.) ICD-9 code 305.1 (tobacco disorder).
If billing an office visit on the same day as the tobacco cessation counseling codes, modifier -25 should be appended to the appropriate E&M code.
The estimated reimbursement for CPT codes 99406 and 99407 is $14.00 - $26.00 per visit, based on national Medicare allowances.
You can read the complete coverage guidelines at: www.cms.gov/center/coverage.asp
Go to the NCAs and locate the "Smoking & Tobacco Use Cessation Counseling" section.
Remember, all new CPT codes are effective January 1, 2011.
Thank you to all our newsletter subscribers, and Happy Holidays! 
If you have any questions or need additional information regarding this article, please contact Cindy Tipton-Cain at Cindy_Cain@MED3000.com
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