Smoking and Alcohol Addiction: Tough Codes to Crack!
Be Ready as More Patients Seek Help
By Meera Mohanakrishnan, MSc, CPC
There are two codes for tobacco use cessation counseling and two codes for alcohol and/or substance abuse screening and brief intervention for providers to use. These codes differ from evaluation and management (E/M) services that should be reported separately for patients with a behavior considered an illness, such as tobacco use, substance abuse, or obesity. The four CPT® codes are as follows:
99406 Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes
99407…greater than 10 minutes
99408 Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services; 15 to 30 minutes
99409 …greater than 30 minutes
Kick Bad Coding Habits
Tobacco use is the leading cause of preventable disease and death in the United States. Smoking affects nearly every organ of the body. Tobacco dependence is a chronic condition that often requires repeat intervention. The benefits are greater for those who quit at an early age; however, smoking cessation is beneficial at any age.
Smoking cessation counseling consists of a physician providing patients with information to help them stop smoking. Smoking cessation counseling includes the following steps:
Step 1: Asking the smoker about smoking status and history.
Step 2: Counseling the smoker to help him or her to stop smoking.
Step 3: Assessing the smoker’s willingness to set a quit date.
Step 4: Assisting the smoker using a written plan. If appropriate, the “assisting” step may also include prescribing smoking cessation pharmacotherapy, as needed.
Step 5: Tracking the progress of the smoker’s attempt to stop smoking.
Cessation Counseling Session
A cessation counseling session is the face-to-face patient contact at one of two levels: intermediate (greater than 3 minutes and up to 10 minutes), or intensive (greater than 10 minutes). During a 12-month period, the physician and the beneficiary have the freedom to choose between intermediate or intensive counseling strategies for each session.
Check Codes Carriers Accept
In March 2005, the Centers for Medicare and Medicaid Services (CMS) created two G codes for smoking cessation, G0375 and G0376. The G codes have been deleted and replaced by the new CPT® codes.
Claims for smoking and tobacco use cessation counseling services should be submitted with a suitable medical necessity code. Diagnosis codes should indicate the condition that is adversely affected by tobacco use or the condition treated with a therapeutic agent whose metabolism or dosing is affected by tobacco use.
Sobering Medicare Rules and Coverage
Medicare provides coverage of smoking and tobacco-use counseling for beneficiaries who meet one of the following criteria:
- Use tobacco and have a disease or an adverse health effect due to tobacco use; or
- Take a therapeutic agent whose metabolism or dosing is affected by tobacco use as based on Food and Drug Administration (FDA)-approved information.
- Medicare will cover two cessation attempts per year.
- Each attempt may include a maximum of four counseling sessions.
- The total annual benefit covers up to eight cessation counseling sessions in one year.
- The beneficiary may receive a further set of eight counseling sessions during a second or subsequent year.
- A cessation counseling attempt includes the following: up to four cessation counseling sessions (one attempt = up to four sessions) and two cessation counseling attempts (or up to eight cessation counseling sessions) are allowed every 12 months (for example, if the first of eight covered sessions was performed in July 2007, a second set of eight sessions may begin in July 2008).
- Beneficiaries must be competent and alert at the time services are provided.
- These eligible beneficiaries are covered under Medicare Part B. The coinsurance or co-payment applies after the yearly Medicare Part B deductible has been met.
In 1980, a World Health Organization (WHO) committee stressed the need for efficient methods to identify people with harmful and hazardous alcohol consumption before apparent health and social consequences arise. Alcohol screening, assessment, and intervention are difficult and time consuming, and only two to three people out of 1000 screened benefit from them. In the case of a positive screening result, the physician makes a more detailed assessment of the patient’s drinking.
If the assessment confirms the screening result, the patient receives a brief intervention, typically comprising of:
- Feedback on present drinking habits
- Information on health risks of hazardous drinking and on the benefits of sensible drinking
- Advice to cut down or avoid binge drinking
- Self help materials are often supplied and follow up consultations offered
Use Codes Sensibly
CPT® codes 99408 and 99409 were introduced in CPT® 2008. Research shows that using the new codes will be very cost-effective.
For Medicare services, the following HCPCS Level II codes should be used:
G0396 Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes
G0397 Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes
Medicare has announced that it will not pay for the new CPT® codes as the description of the code includes a screening service, which it does not cover. Medicare also created two new G codes that are nearly identical to the CPT® codes, but has changed the word “screening” to “assessment.” Private insurers may pay for the CPT® codes for this service, but are unlikely to use the G codes. Now in 2008, physicians have four different codes for screening and brief intervention (SBI). Two of the codes are for privately insured patients (99408 and 99409), and two for Medicare patients (G0396 and G0397).
CMS announced two new HCPCS Level II procedure codes for Medicaid services, effective Jan. 2008:
H0049 Alcohol and/or drug screening
H0050 Alcohol and/or drug services, brief intervention, per 15 minutes
Research reveals that physicians can play a positive role in influencing patients’ health decisions about substance abuse. Screening and brief intervention can help to change an individual’s harmful drinking and smoking when offered by primary care physicians or in trauma settings. Although these intervention services may be helpful; when reporting the new codes, reimbursement from insurers is not always guaranteed.