MDinTouch Blog Coding Tip: How To Get Paid For Smoking Cessation

THE CODES:99406- Smoking and tobacco cessation counseling visit for the symptomatic patient, intermediate, greater than 3 minutes up to 10 minutes.99407-intensive, greater than 10 minutes.G0436- Smoking and tobacco cessation counseling visit for the asymptomatic patient, intermediate, greater than 3 minutes up to 10 minutes.G0437- intensive, greater than 10 minutes.CMS specifies symptomatic patient criteria as beneficiaries "who use tobacco and have been diagnosed with a recognized tobacco-related disease or who exhibit symptoms consistent with a tobacco-related disease."Medicare allows for a total of 8 sessions per year, 4 intermediate and 4 intensive. Each insurance has their own guidelines. Please verify coverage. DOCUMENTATION:As with any time-based service the documentation must include sufficient detail to support the claim. Proper documentation should include the total time spent face-to-face with the patient and what was discussed. The patient's desire or need to quit tobacco use, the cessation techniques and resources, estimated quit date and planned follow up should be noted within the patient's chart note. Without this information, medical necessity for coverage may be questioned and could result in denied or delayed payments. Examples of incomplete documentation:• I have counseled the patient again to quit smoking. The patient verbalized understanding but is not ready to quit.• 3+ minutes spent counseling patient on tobacco use.Example of complete documentation:Mary is a 67-year-old female who presents with exacerbated COPD on oxygen. She continues to smoke one pack of cigarettes per day after several failed attempts at quitting. Approx. 15 minutes was spent counseling the patient on cessation techniques and resources provided. She understands continuing to smoke could lead to stroke and death. The benefits of stopping were also presented to her. She verbalized her desire to "give it up." She has set goals of 30 days to be completely smoke free. We will follow up again in 2 weeks to check progress.Coded as 99407, with Dx F17.218 nicotine dependency on cigarettes with other nicotine induced disorders and J44.1, COPD with exacerbation. ----------If you have any questions, please reach out to your MDinTouch Account Representative.New to MDinTouch? Feel free to contact us to learn more about our EMR Medical Billing Service:Call 866-774-0002 or visit www.EMRMedicalBillingService.com