SMOKING AND TOBACCO USE CESSATION COUNSELING
Originally Posted by MelanieB
Tobacco use continues to be the leading cause of preventable disease and death in the United States. Although smoking rates have significantly declined, 9.3 percent of the population age 65 and older smokes cigarettes. Approximately 440,000 people die annually from smoking related diseases, with the majority of deaths - 68 percent (300,000)â€”being among people ages
65 and older.
Smoking can attribute to and exacerbate heart disease, stroke, lung disease, cancer, diabetes, hypertension, osteoporosis, macular degeneration, abdominal aortic aneurysm, and cataracts.
Smoking harms nearly every organ of the body and generally diminishes the health of smokers.
Quitting tobacco use can be difficult. Most smokers are dependent on nicotine, the psychoactive drug in tobacco products that produces dependence. Nicotine dependence is the
most common form of chemical dependence in the U.S. Research suggests that nicotine is as addictive as heroin, cocaine, or alcohol. Quit attempts may be accompanied by symptoms of withdrawal, including irritability, anxiety, difficulty concentrating, and increased appetite.
Tobacco dependence is a chronic condition that often requires repeated intervention.
Quitting smoking has immediate as well as long term affects. People who stop smoking greatly reduce their risk of dying prematurely and lower their risk of heart disease, stroke, lung disease and other heath conditions caused by smoking. Benefits are greater for people who stop at earlier ages, but smoking cessation is beneficial at any age.
Older smokers have been shown to be more successful in their attempts to quit than younger smokers and respond favorably to their providersâ€™ advice to quit smoking. Brief clinical interventions and counseling by health care providers have been shown to increase the chances of successful cessation.
The Centers for Medicare & Medicaid Services (CMS) determined the evidence was adequate to conclude that smoking and tobacco-use cessation counseling, based on the current U.S. Public Health Service Guideline, is reasonable and necessary for certain individuals and should be covered by Medicare. Effective for services performed on or after March 22, 2005, Medicare provides coverage of two levels of counseling for smoking cessation (intermediate and intensive).
Coverage Information Medicare provides coverage of smoking and tobacco-use counseling for beneficiaries who meet one of the following criteria:
Â· Use tobacco and have a disease or an adverse health effect that has been found by the
U.S. Surgeon General to be linked to tobacco use; or
Â· Are taking a therapeutic agent whose metabolism or dosing is affected by tobacco use as based on Food and Drug Administration-approved information.
Medicare will cover two cessation attempts per year. Each attempt may include a maximum of four counseling sessions. The total annual benefit covers up to eight smoking and tobacco-use cessation counseling sessions in a 12-month period. The beneficiary may receive another eight counseling sessions during a second or subsequent year after 11 full months have passed since the first Medicare-covered cessation counseling session was performed. For example, if the first of eight covered sessions was performed in April 2007, a second series of eight sessions may begin in April 2008.
Intermediate and intensive smoking cessation counseling services will be covered for outpatient and hospitalized beneficiaries who are smokers and meet all coverage requirements as long as Coverage Issues â€“ Page 2
those services are furnished by qualified physicians and other Medicare-recognized practitioners. Beneficiaries must be competent and alert at the time services are provided.
Eligible beneficiaries are covered under Medicare Part B. The coinsurance or copayment applies after the yearly Medicare Part B deductiblehas been met.
Note: Medicareâ€™s prescription drug benefit also covers smoking and tobacco-use cessation agents prescribed by a physician.
Cessation Counseling Attempt
A cessation counseling attempt occurs when a qualified physician or other Medicare-recognized practitioner determines that a beneficiary meets the eligibility requirements and initiates treatment with a cessation counseling attempt.
A cessation counseling attempt includes the following:
Â· Up to four cessation counseling sessions (one attempt = up to four sessions)
Two cessation counseling attempts (or up to eight cessation counseling sessions) are allowed every 12 months.
Cessation Counseling sessIon
A cessation counseling session refers to face-to-face patient contact at one of two levels:
Â· Intermediate (greater than 3 minutes up to 10 minutes); or
Â· Intensive (greater than 10 minutes).
The following HCPCS codes should be reported when billing for smoking and tobacco-use cessation counseling services:
Â· 99406 - Smoking and tobacco-use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes
Â· 99407 - Smoking and tobacco-use cessation counseling visit; intensive, greater than 10 minutes
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.
Â· G0375 - Smoke/Tobacco counseling 3-10 minutes.
Â· G0376 - Smoke/Tobacco counseling greater than 10 minutes.
Smoking and tobacco use cessation counseling claims are to be submitted with the appropriate diagnosis code.
Diagnosis codes should reflect:
Ã˜ The condition the patient has that is adversely affected by the use of tobacco; or
Ã˜ The condition the patient is being treated for with a therapeutic agent whose metabolism is affected by the use of tobacco.
Note: Providers are reminded that they should keep on file appropriate documentation in the patientâ€™s medical records to adequately demonstrate that Medicare coverage conditions were met for any services provided and billed to Medicare for smoking and tobacco use cessation counseling.
Physicians and other Medicare-recognized practitioners who need to bill for E&M services on the same day as smoking cessation services are billed should use the appropriate HCPCS code in the 99201-99215 range AND modifier 25 to show that the E&M service is a separately identifiable service from a smoking and tobacco-use cessation counseling service.
Note: Effective April, 1, 2006, Medicare providers will be given the capability to view the number of smoking and tobacco-use cessation counseling sessions provided to a beneficiary. Providers will be able to access this file through the CWF, by entering the beneficiaryâ€™s health insurance claim number (HICN).
Ultimately, the capability to view the number of smoking and tobacco-use cessation counseling sessions provided to a beneficiary gives providers the ability to determine a beneficiaryâ€™s available coverage for this service.
Chastity Nault, CPC
HIM Professional Services Coder - Remote