Smoking Cessation

epitale

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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
 

cedwards

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Hamden
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It is my understanding that you would still bill the G codes to Medicare for smoking cessation. The 99406-99407 were created for other payors. You can bill an E/M service (with a 25 modifier) with these codes but it must be distinct and the time spent providing the cessation services may not be used as a basis for the E/M code selection. Remember, your documentation for both services must be able to stand alone to support the services billed.
 

relong

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Bettendorf, Iowa
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We have only gotten these paid when adding a 25 to the ov code, and not all payers reimburse for it. We are an oncology practice and the smoking cessation is done separately and in addition to the patient's visit.
 

efrohna

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Appleton
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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

I forgot to add that TIME should be documented in the note since these are time based codes. In addition, watch the diagnosis! 305.1 cannot be linked to these codes. Medicare wants a medically necessary diagnosis, an underlying disease to the smoking (ie: COPD, asthma, etc.). I agree that some payers do not pay separately for this (yet) as they include it with the E/M. Good luck!
 

maysons1703

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Temple
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What is the criteria for smoking cessation counseling? Is advicement to quit enough, or does a standardized curriculum have to be followed?
 

efrohna

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Appleton
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This link may help you determine what the documentation should look like:
http://www.surgeongeneral.gov/tobacco/tobaqrg.htm

The 5 A's to quitting is what we look for with these codes (see below).
1. Ask: Have you used tobacco in the last 12 months?
2. Advise: Advise to quit in a clear, strong and personalized manner.
3. Assess: On a scale from 1 to 10 how interested are you in trying to quit?
1 = No 5 = Somewhat 10 = Eager to quit.
4. Assist: Counsel, booklet, pharmacotherapy, 1-800-QUIT-NOW support.
5. Arrange a follow up: 4 to 6 weeks to assess patient.

Hope this helps.
 

cdcpc

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Thanks!

Evangelina,
Your sources on smoking cessation have been a HUGE help. Thank you so much for posting them :)
 

TCarrasco

Contributor
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smoking cessation

Hi All,

We hava a provider that insists on billing smoking cessation to 7yr olds, 23 month olds, and even newborns! He says that he is counseling the parents and should be able to bill for these services. Since these are new codes to our practice, I am not sure if he can do this. Most of the patients he sees are on Medicaid. Please if anyone could help me, I would greatly appreciate it!!:confused:
 

rthames052006

True Blue
Local Chapter Officer
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York, Pa
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I forgot to add that TIME should be documented in the note since these are time based codes. In addition, watch the diagnosis! 305.1 cannot be linked to these codes. Medicare wants a medically necessary diagnosis, an underlying disease to the smoking (ie: COPD, asthma, etc.). I agree that some payers do not pay separately for this (yet) as they include it with the E/M. Good luck!
What I find funny is that we have been billing this code but never on a Medicare pt so far, we have had some insurances pay for these codes I am going to run a report to see what insurances are paying us... If I had to count on my hand how many we've billed I'd have to say about a dozen to date....
 

efrohna

Guru
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Appleton
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Hi All,

We hava a provider that insists on billing smoking cessation to 7yr olds, 23 month olds, and even newborns! He says that he is counseling the parents and should be able to bill for these services. Since these are new codes to our practice, I am not sure if he can do this. Most of the patients he sees are on Medicaid. Please if anyone could help me, I would greatly appreciate it!!:confused:
TCarrasco,
What is your provider thinking? The term "smoking cessation" alone means one who wants to quit smoking. Please print off the smoking cessation pamphlet that is on the CMS website, which explains the necessity of the codes. Medicare is also strict on the underlying condition(s) of a person that smokes (ie: asthma, COPD). So the diagnosis 305.1 - tobacco use disorder may be coded 2nd or 3rd, but the underlying condition should be primary. Wisconsin Medicaid does not pay for this code.
 
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