Smoking & Tobacco cessation counseling

[MICHB010375]

Our office billed a 99214 w/ 25 modifier and 99406 both with different codes with a different diagnosis. Medicare denied the 99406 as a duplicate. When I called Medicare for further clarification the rep said we could not bill 2 E/M codes on the same day. Is anyone billing Medicare for this code on the same day and getting reimbursed?

[joglesbee]

Make sure that you have two separate diagnosis codes. Use whatever code for the office visit and then the 305.1 tobacco-use disorder for the 99406.

That should fix the problem with medicare and billing two separate procedures in one day. Biggest thing is making sure to have two diagnosis codes.

[Pwalden729]

We did the above, using 2 separate Dx codes. Medicare paid but applied a psychiatric reduction (PR-122) to our reimbursement, resulting in higher out of pocket for pt. Anyone seeing this?

[RebeccaWoodward*]

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 (now 99406/99407). (Note the above codes are payable for dates of service on or after January 1, 2008. Codes G0375 and G0376, below, are not valid or payable for dates of service on or after January 1, 2008.)

Contractors shall only pay for 8 Smoking and Tobacco-Use Cessation Counseling sessions in a 12-month period. The beneficiary may receive another 8 sessions during a second or subsequent year after 11 full months have passed since the first Medicare covered cessation session was performed. To start the count for the second or subsequent 12-month period, begin with the month after the month in which the first Medicare covered cessation session was performed and count until 11 full months have elapsed.
Claims for smoking and tobacco use cessation counseling services shall be submitted with an appropriate diagnosis code. Diagnosis codes should reflect: the condition the patient has that is adversely affected by tobacco use or the condition the patient is being treated for with a therapeutic agent whose metabolism or dosing is affected by tobacco use.
NOTE: This decision does not modify existing coverage for minimal cessation counseling (defined as 3 minutes or less in duration) which is already considered to be covered as part of each Evaluation and Management (E/M) visit and is not separately billable.

Section 12

http://www.cms.hhs.gov/manuals/downloads/clm104c32.pdf