Oncology & Hematology Coding Alert

Don't let your G0375-G0376 pay go up in smoke

Tobacco-use counseling can benefit lung-cancer patients, but you have to make sure your oncologists get the compensation they deserve from Medicare.
 
Here's how to keep frequency and incident-to slipups off your claims.
 
The lowdown: CMS began covering counseling visits in March 2005. You should list G0375 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) and G0376
(... intensive, greater than 10 minutes) for your oncologist's services.
  
This is an excellent coverage decision, says Beverly Roy, CPC, CCP, a professional coder at Summit Medical Associates in Hermitage, Tenn. The physicians she codes for often counsel patients with lung cancer about quitting, and the doctors deserve to get paid for what they do, she says. Track the Number of Sessions Medicare allows two counseling attempts every 12 months. Each attempt includes up to four intermediate or intensive sessions, for a total of eight possible visits in a year, says Leslie Witkin, founder of Physicians First in Orlando, Fla. You can report either an intermediate (G0375) or intensive (G0376) code per session, depending on the amount of time the physician or other qualified provider (such as a physician assistant or nurse practitioner) spent with the patient, she says.
  
-We report G0376 the most often for the first visit because that's when our physicians typically provide the most in-depth counseling,- Roy says. During that first visit, the physician typically addresses the five A-s, she says:
 
1. Ask about tobacco use.
 
2. Advise the patient to quit.
 
3. Assess the willingness to attempt to quit.
 
4. Assist with the attempt to quit.
 
5. Arrange a follow-up for the patient to come back within a week of the quit date.
 
-Because these are time-based codes, I strongly urge physicians to document the amount of time they spent with the patient,- Witkin says. -If you don't document time with the patient, you-ll run into trouble if Medicare audits your records.-
  
Coding scenario: Your physician counsels a Medicare patient with lung cancer. During the month, the physician holds four sessions. Each session lasts more than 10 minutes, so you could report G0376 four times -- once for each session. Then, the physician starts a second attempt with the same patient. This time you report three intermediate sessions (G0375) and one intensive (G0376).
  
Heads-up: If the session lasts less than three minutes, don't report one of the counseling codes. You should include that time with the appropriate E/M code (99201-99215), Roy says. Be Aware of Diagnosis Code Rules When choosing an ICD-9 code, you should report the condition that the smoking or tobacco use is harming, Witkin says. For instance, in the scenario above, you could list lung cancer (162.0-162.9, Malignant neoplasm of trachea, [...]