Cardiology Coding Alert

Question: Can we report 99406 and 99407 separately and in addition to other E/M services the cardiologist performs on the same date? Do we need to append a modifier?

Colorado Subscriber

Answer: Yes. You can report smoking and tobacco-use cessation counseling codes 99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) and 99407 (Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes) separately and in addition to other E/M services the cardiologist performs on the same date. However, you must make sure the situation fits the guidelines set forth by the CPT^® manual.

According to CPT^®, any E/M services the cardiologist reports on the same date as 99406 and 99407 must be distinct, and you must append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service). The manual adds that the cardiologist cannot use the time he spent providing the behavior change intervention services as the basis for the E/M code selection.

The Medicare Administrator Contractor (MAC) National Government Services (NGS) adds its own take on this issue: "Medicare will allow payment for a medically necessary E/M service on the same date as tobacco cessation counseling, provided it is clinically appropriate and medically necessary," says NGS. "Such E/M service should be reported with modifier 25 to indicate it is separately identifiable from the tobacco use service."