Pulmonology Coding Alert

Question: Are asymptomatic tobacco users now eligible for coverage for tobacco cessation counseling? What are the coding related ins and outs pertaining to the same?

Rhode Island Subscriber

Answer: Yes. Smoking and any other tobacco-use cessation counseling is now covered under Medicare. Earlier, only those patients were covered who were diagnosed with a tobacco-related condition or those showing symptoms of a tobacco-related condition. However, from 2010 onward, even those beneficiaries not currently showing any signs or symptoms of any tobacco-related condition are eligible for counseling.

Depending on the time spent for the counseling sessions for an asymptomatic Medicare patient, you can report it as G0436 (Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes) or G0437 (Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes) for patients that are covered under Medicare. For all other payers not following Medicare guidelines and for symptomatic Medicare patients whom you are counseling therapeutically (rather than preventively, as with G0436 and G0437), you can report 99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) or 99407 (Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes).

Two attempts at cessation of use are covered for counseling, and only four counseling sessions are covered per attempt. Consequently, you can only get coverage for a maximum of eight sessions in a calendar year. After the usage of eight sessions within the year, another round of counseling is allowed only after the passage of 11 months since the first Medicare-covered cessation counseling session. For example, if the patient started the first of his eight covered sessions in January 2014, then the waiting period is applicable from February 2014, and the beneficiary can receive a second series of eight sessions in January 2015 independent of when he finished his first series.