Cardiology Coding Alert


CMS Manuals Offer 99406 Info

Question: Does the cardiologist need to document a plan and referral to a treatment center to support smoking cessation counseling?

Utah Subscriber

Answer: An action plan and referral are not part of CMSs national requirements for reporting smoking counseling cessation. The Medicare National Coverage Determinations Manual, Section 210.4, and Medicare Claims Processing Manual (MCPM), Chapter 32, Section 12.6 (Post-Payment Review for Smoking and Tobacco-Use Cessation Counseling Services), do not require covered counseling to include a plan for the patient to quit or a referral to a treatment center.

Take note: MCPM, Chapter 32, Section 12.6, states that Providers must keep patient record information on file for each Medicare patient for whom a Smoking and Tobacco-Use Cessation Counseling claim is made. These medical records can be used in any post-payment reviews and must include standard information along with sufficient patient histories to allow determination that the steps required in the coverage instructions were followed.

Also, the NCD manual notes that Minimal counseling is already covered at each evaluation and management (E&M) visit. Minimal cessation counseling is defined as three minutes or less, according to MCPM, Chapter 32, Section 12.1.

Nationally, Medicare has a frequency limitation for both 99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) and 99407 (& intensive, greater than 10 minutes). Ensure the patient has not exceeded these benefits:

" Year 1: Two attempts in a 12-month period. Each attempt may include a maximum of four counseling sessions. A qualified physician or other Medicare recognized practitioner determines that a beneficiary meets the eligibility requirements and initiates treatment with a cessation counseling attempt. So a beneficiary may receive eight smoking and tobacco-use cessation counseling sessions in a 12-month period.

" Year 2: Another eight counseling sessions during a second or subsequent year after 11 full months have passed since performing the first Medicare-covered cessation counseling session. For example, if you performed the first of eight covered sessions in May 2008, a second series of eight sessions may begin in May 2009.

Dont forget: Coverage requires a diagnosis codes reflecting the condition the patient has that is adversely affected by tobacco use or the condition the patient is being treated for with a therapeutic agent whose metabolism or dosing is affected by tobacco use, according to MCPM, Chapter 32, Section 12.1.

--  You Be the Coder and Reader Questions prepared with the assistance of Jim Collins, CCC, CPC, ACS-CA, CHCC, president of CardiologyCoder.Com.