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Coding for Smoking Cessation - New Codes Jan 1, 2011


By ljohnson - Posted on 31 October 2010

Smoking/Tobacco Cessation Per CMS

Leslie Johnson, CCS-P, CPC

 

Effective for claims with dates of service on and after August 25, 2010, CMS will cover tobacco cessation counseling for outpatient and hospitalized Medicare beneficiaries:

 

1) who use tobacco, regardless of whether they have signs or symptoms of tobacco-related disease;

2) who are competent and alert at the time that counseling is provided; and

3) whose counseling is furnished by a qualified physician or other Medicare-recognized practitioner

 

Diagnosis Codes to Use:

 

Appropriate diagnosis codes that must be used are: 305.1 (non-dependent tobacco use disorder) or V15.82 (history of tobacco use) or the claims will deny.

 

With other E/M Service

 

Medicare will allow payment for a medically necessary Evaluation and Management (E/M) service on the same date as tobacco cessation counseling, provided it is clinically appropriate. Such E/M service should be reported with modifier 25 to indicate it is separately identifiable from the tobacco use service.

 

CPT/HCPCS Codes to Use

 

Before January 1, 2011

CPT codes 99406 and 99407 are used for tobacco cessation counseling for symptomatic individuals.

 

On or After January 1, 2011

Medicare will waive the deductible and coinsurance/copayment for counseling and billing with these two new G codes on or after January 1, 2011:

 

G0436: Long Descriptor: Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes,

 

Short Descriptor: Tobacco-use counsel 3-10 min;

 

G0437: Long Descriptor: Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes,

 

Short Descriptor: Tobacco-use counsel >10 min.

 

OPPS/Facility Payment & Coding

 

Medicare will pay claims not paid under the Outpatient Prospective Payment System (OPPS) with dates of service on or after August 25, 2010, through December 31, 2010, but received prior to January 1, 2011, when billed with diagnosis code 305.1 (non-dependent tobacco-use disorder) or V15.82 (history of tobacco use) and unlisted HCPCS code 99199 for Counseling to Prevent Tobacco Use Services. Code 99199 is Medicare contractor-priced.

 

However, two new, temporary C codes have been created for facilities paid under the OPPS when billing for Counseling to Prevent Tobacco Use and Tobacco-Related Disease services during the interim period of August 25, 2010, through December 31, 2010. (Facilities paid under the OPPS may not bill the unlisted 99199 code.)

 

The two new C codes are:

 

C9801: Long Descriptor: Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes,

Short descriptor: Tobacco-use counsel 3-10 min;

 

C9802: Long Descriptor: Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes,

Short descriptor: Tobacco-use counsel >10 min.

 

Utilization and Timing Information:

CMS will allow two individual tobacco cessation counseling attempts per year. Each attempt may include a maximum of four intermediate OR intensive sessions, with a total benefit covering up to 8 sessions per year per Medicare beneficiary who uses tobacco. The practitioner and patient have the flexibility to choose between intermediate (more than 3 minutes up to 10 minutes) or intensive (more than 10 minutes) cessation counseling sessions for each attempt.

 

NOTE: When calculating a 12-month period, 11 months must pass following the month in which the 1st Medicare covered cessation counseling session was performed.

 

CMS MedLearn Matters here until they change the URL: http://www.cms.gov/MLNMattersArticles/downloads/MM7133.pdf

 

CPT® is registered trademark of the American Medical Association.

CPT copyright 2009 American Medical Association

 

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