Internal Medicine Coding Alert

Published on Mon Apr 19, 2004 PDF

Question: Will Medicare insurers pay for smoking-cessation treatments? If so, what codes and documentation should we use?

New York Subscriber

Answer: Usually, when a health professional other than a physician provides smoking-cessation treatments, you could report G9016 (Smoking-cessation counseling, individual, in the absence of or in addition to any other evaluation and management service, per session [6-10 minutes] [demo project code only]). If the physician counsels the patient regarding smoking, you should include this service with the E/M code.
 
Remember that Medicare will not pay for G9016 because the government lists it as a "demo project code." And many private payers may not pay for this service, so check with your individual carrier before filing the claim.
 
You may be able to report smoking cessation as health and behavior intervention (96152-96153, Health and behavior intervention, each 15 minutes, face-to-face ...) for patients with smoking-related health problems, such as emphysema (492.x). But you should report them only when a nonphysician professional provides 15 minutes of face-to-face intervention.

 - Answers for You Be the Coder and Reader Questions were reviewed by Kathy Pride, CPC, CCS-P, a coding consultant for QuadraMed in Port St. Lucie, Fla.; and Bruce Rappoport, MD, CPC, a board-certified internist who works with physicians on compliance, documentation, coding and quality issues for RCH Healthcare Advisors LLC, a Fort Lauderdale, Fla.-based healthcare consulting company.