Wiki Smoking Cessation billing

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jhendrix08

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Hi!

I'm hoping some of you have experience with billing and reimbursement for CPT 99406/99407 smoking cessation counseling. We are an internal medicine practice (pcp) and are looking for some guidance on billing requirements. I read that Medicare covers 8 cessation counseling sessions per year (not per provider) so that part I understand.

When are we allowed to bill for it? Can it be billed at the same time as a annual physical (for non Medicare) or at the same time as a Medicare Wellness visit G0438/G0439? Do we just need to add modifier 25 to the E/M?

I would greatly appreciate any feedback. THANKS!!
 
Smoking Cessation Billing and Dx Assigned

Hello

Yes had experience billing for this....use G code for Medicare patients and the CPT 99406 to 99409 for commerical insurance. Ensure doc or NP write on med record gave smoking cessation counseling 3 minutes up to 10 minutes in visit documentation. Plus other chronic or current illness reason for office visits for the day. Once this is down in notations you can use the CPT 99406 etc and assigned the IDC10 dx. code Z code Z87.891 but better dx. is F17.201 blocks.

Also if patient has heart or gastro condition or doing another visit doc may want to add this to regular office visit the smoking counseling. Smoking ciggs is not good for heart, respiratory or gastro illnesses. Just saying. So the CMS 1500 claim would list the eval mgnt office code of new or established, then next line on claim be a CPT 99406 to 99409. Ensure the dx code are linked properly for each CPt and in coordination with documentation from physician or NP or PA. Also use proper modifier for NP or PA providers.

I hopes this helps you

Lady T
 
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