Wiki Smoking Cessation - modifier on the E&M

[epitale]

Is anyone using the smoking cessation codes to bill Medicare 99406 & 99407?
If so can you help educate me on the changes.
Before we could bill the G codes (G0375 & G0376) with the E&M, now someone has said we need a modifier on the E&M. It is my understanding that these codes 99406 & 99407 can billed in addition to the E&M with no modifier.
Please help educate me.
Thanks EM

 

[mcpalmeter]

Smoking Cessation

Hi.

In answer to your question, Medicare guidelines changed to reflect CPT's creation of codes for smoking cessation so use the 99406-99407 codes instead of the G codes now. The Medicare Claims Processing Manual has not yet been updated to reflect the code changes from the G-codes but that was covered in CMS transmittal 1433 (Change Request 5878) dated 02/01/08. But the Manual language does address your question about billing with a medically necessary E/M service in Chapter 32, Section 12.1:

Contractors shall allow payment for a medically necessary E/M service on the same day as the smoking and tobacco-use cessation counseling service when it is clinically appropriate. Physicians and qualified non-physician practitioners shall use an appropriate HCPCS code, such as HCPCS 99201– 99215, to report an E/M service with modifier 25 to indicate that the E/M service is a separately identifiable service from G0375 or G0376.

I hope you have found this post helpful.

Regards,

Maryann C. Palmeter, CPC