Otolaryngology Coding Alert

Good news: CMS gives you more options for coding this service

If your allergist counsels a Medicare patient about his tobacco use, you can code this visit if you know when it occurred and how long it lasted. Also, you-ll need a primary ICD-9 that reflects the tobacco-related condition.

CMS began covering the counseling visits on March 22. But 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) only for visits the allergist provided on July 5 or after.

For visits he performed between March 22 and July 4, use unlisted-procedure code 99199 (Unlisted special service, procedure or report), according to CMS Transmittal 562. Note that these coding guidelines apply only to Medicare payers. Private insurers will have their own tobacco-counseling policies that you should follow.

This is an excellent coverage decision, says Beverly Roy, CPC, CCP, a professional coder at Summit Medical Associates in Hermitage, Tenn. Physicians often counsel patients about quitting, so they deserve to get paid for that service. 1. Don't Let Frequency Limits Confuse You Important: 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) spends with the patient, she says.

Typically, you-ll use G0376 for the first visit because that's when your physician will 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 initiates a counseling attempt on a Medicare patient with cough-variant asthma (493.82), which the physician has linked to the beneficiary's lifelong smoking. During the month, the physician holds four sessions. Each session lasts more than 10 minutes, so you could report the first attempt as G0376 for each session. Then, the allergist starts a second attempt with the same patient. This time the physician bills for three intermediate sessions and for one intensive. You [...]