Pediatric Coding Alert

Question: At a problem-oriented visit, a pediatrician counsels a mother about how her secondhand smoke is affecting her child. Changing the parent's habit would benefit the patient. Can I bill 99406-99407 for the child?

Illinois Subscriber

Answer: No, codes 99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) and 99407 (... intensive, greater than 10 minutes) require that the patient receive the counseling, according to the AMA. You would instead use the appropriate level office visit code (99201-99215, Office or Other Outpatient Services). Remember that if counseling dominates the encounter, you can code the visit based on time, provided the documentation includes the visit's total face-to-face physician-patient time, the counseling time, and the topics discussed.

You could use 99406 or 99407 for counseling a teenager to stop smoking. These codes "describe individual behavior change interventions and are reported for the individual receiving the service," states CPT Assistant September 2009.

Exception: Payers may decide to offer some allowance or coverage through some insurance policies, the Q&A notes. So check if your major insurers approve of using 99406 and 99407 for parental smoking cessation counseling when the child is the patient.