Oncology & Hematology Coding Alert

Question: A Medicare patient with no symptoms of a tobacco related condition presents to the physician for smoking cessation counseling after a screening for breast cancer. Are we correct in reporting code 99406 with the office visit?

Alabama Subscriber

Answer: Yes, you should use 99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes, up to 10 minutes) or 99407 (...intensive, greater than 10 minutes). These codes are appropriate to report for preventive counseling.

From a Medicare standpoint, CMS covers tobacco use prevention counseling for outpatient and hospitalized Medicare beneficiaries as long as the session meets the following criteria:

• Patient uses tobacco (regardless of whether he has signs or symptoms of tobacco-related disease)
• Patient is competent and alert at the time the counseling is provided
• A qualified physician or other Medicare-recognized practitioner performs the counseling.

"From a CPT^® perspective, codes 99406 and 99407 may be used for either preventive or therapeutic counseling; it is the diagnosis code that distinguishes the purpose of the counseling," notes a coding specialist.