Wiki 99406 and Desire to quit

[Rebecca Pate]

My question is this: Does the patient have to have a desire to quit smoking in order to bill 99406? I am seeing documentation stating "patient is not ready to quit".

 

[thomas7331]

Typically yes, the patient should want to quit smoking in order to receive this service. The code represents the provider's work in assisting the patient to quit - e.g. counseling on techniques and giving resources that are available to support the smoking cessation effort. The code is not meant to be billed simply because the provider tells the patient that they should quit.

 

[Rebecca Pate]

Thank you! That's what I thought. Just wanted some agreement.

 

[Rebecca Pate]

Typically yes, the patient should want to quit smoking in order to receive this service. The code represents the provider's work in assisting the patient to quit - e.g. counseling on techniques and giving resources that are available to support the smoking cessation effort. The code is not meant to be billed simply because the provider tells the patient that they should quit.

Is there any documentation that states that? My provider is pushing back.

 

[thomas7331]

CPT includes this additional information in the section notes for these codes: Behavior change services involve specific validated interventions of assessing readiness for change and barriers to change, advising a change in behavior, assisting by providing specific suggested actions and motivational counseling, and arranging for services and follow-up. I think it's clear from this that the service is more specific and more involved than simply recommending to a patient they need to quit - it is an intervention aimed at changing behavior. If the provider is recommending quitting because it is exacerbating a condition, then that is part of the treatment of the illness, and part of the E&M directed at the condition. Cessation counseling is something more than just this - it's an effort to assist the patient with their attempt at quitting and the patient needs to be consenting to and participating in this.

You might want to point out to the provider (and probably in gentler language than I'm using here) that patients have a right to choose if and when they want to receive a service and use the benefits that they have under their insurance plans and that it is not up to the provider to decide for them that they are going to have it or not. Think of it this way: if you took your car in and asked for an oil change, and they did a few extra things that you didn't want but that they thought you should have, and also charged you for them, you likely wouldn't be too happy about it, would you?

 

[Bernadette10]

An auditor with my company said smoking cessation counseling can still be billed even if the patient doesn't agree to quit. Below is my question. I guess there are different interpretations, but I'll have to go by her answer.

Is this enough to bill smoking cessation counseling 99406? I thought it would be, even though he's not willing to quit at this time. Or since the CPT description includes "behavior change intervention" in this category of codes, does the patient need to be willing to quit in order to bill this? The patient smokes 1/2 pack of cigarettes per day. He was counseled on smoking cessation today. We discussed the adverse effects of smoking including the increased risks of heart attack (MI), stroke, emphysema and COPD and lung cancer. We discussed discontinuation methods, including smoking cessation program. The patient was advised to quit and decided not to quit at the present time. Time spent in counseling was between 3 and 10 minutes.

 

[medicalauditor]

An auditor with my company said smoking cessation counseling can still be billed even if the patient doesn't agree to quit. Below is my question. I guess there are different interpretations, but I'll have to go by her answer.

Is this enough to bill smoking cessation counseling 99406? I thought it would be, even though he's not willing to quit at this time. Or since the CPT description includes "behavior change intervention" in this category of codes, does the patient need to be willing to quit in order to bill this? The patient smokes 1/2 pack of cigarettes per day. He was counseled on smoking cessation today. We discussed the adverse effects of smoking including the increased risks of heart attack (MI), stroke, emphysema and COPD and lung cancer. We discussed discontinuation methods, including smoking cessation program. The patient was advised to quit and decided not to quit at the present time. Time spent in counseling was between 3 and 10 minutes.

I am an auditor and I disagree, for several reasons. 1) Providing the patient with information on the adverse effects of smoking is not counseling, that is general information and one can look up the adverse effects of smoking and cessation methods online, that is not counseling. Counseling is a person-specific session that addresses that specific individual patient's circumstances, health, barriers to change, assessing their behavior and advising ways to change it by suggesting specific actions and providing motivational counseling. (These are not my words, look up the CPT code book, it describes what behavior change services are). I don't see any of this in the details that you provided. 2)CPT coding guidelines state, among other things "... and arranging for services and follow-up." - If the patient is not ready to quit, where is the question of arranging for services and follow-up? 3) AAPC has an article on 99406 and I quote from it - "“As with any time-based evaluation and management (E/M) service, documentation must include sufficient detail to support the claim. Proper documentation for tobacco-use cessation counseling should include the total time spent face to face with the patient, and what was discussed. The patient’s desire or need to quit tobacco use, cessation techniques and resources, estimated quit date, and planned follow up should be noted within the patient’s medical record. Without this information, medical necessity for coverage may be questioned, which could result in denied or delayed payment. Without documentation of significant and separately identifiable work, the payment for smoking cessation counseling may be included in the payment for the primary E/M service.” Hope this helps.