Cardiology Coding Alert

Question: If Medicare has G codes for smoking cessation visits, why does the fee schedule say 99406 and 99407 are active codes?

Florida Subscriber

Answer: Codes 99406-99407 (Smoking and tobacco use cessation counseling visit ...) are appropriate when reporting services for patients symptomatic of tobacco-related diseases. For asymptomatic patients, you should use the G codes:

• 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.

For services on or after Aug. 25, 2010, Medicare covers counseling to prevent tobacco use for patients who (1) use tobacco, (2) are competent and alert at the time of service, and (3) receive counseling from a qualified practitioner. For those patients who aren’t symptomatic for a tobacco-related disease, you must include code 305.1 (Nondependent abuse of drugs; tobacco use disorder) or V15.82 (Personal history of tobacco use) on the counseling claim.

Remember: CMS allows “two individual tobacco cessation counseling attempts per year. Each attempt may include a maximum of four intermediate [more than 3 minutes up to 10 minutes] OR intensive sessions [more than 10 minutes], with a total benefit covering up to 8 sessions per year per Medicare beneficiary who uses tobacco,” according to MLN Matters article MM7133.

Resource: You will find MLN Matters article MM7133, “Counseling to Prevent Tobacco Use,” at www.cms.gov/MLNMattersArticles/downloads/MM7133.pdf.