How do I bill for smoking cessation counseling?
Smoking Cessation Counseling Codes 99406 and 99407 Medicare covers 2 cessation attempts per 12-month period. Each attempt includes a maximum of up to 4 intermediate (99406) or intensive (99407) counseling sessions, with a total Medicare benefit of 8 sessions per year.
What is the CPT code for smoking cessation?
99406 and 99407
In the body of the note, the clinician must document the time of the counseling. The CPT codes for smoking cessation (99406 and 99407) are used for all payers for patients who are symptomatic as a result of smoking.
Do you need modifier 25 with 99406?
If billed alone, 99406 and 99407 are reimbursed. When billed with another evaluation and management code, the codes will bundle to a single fee. To allow payment in this circumstance, providers should append a “25” modifier for 99406 or 99407 codes.
What are the 5as of tobacco cessation?
Successful intervention begins with identifying users and appropriate interventions based upon the patient’s willingness to quit. The five major steps to intervention are the “5 A’s”: Ask, Advise, Assess, Assist, and Arrange. Ask – Identify and document tobacco use status for every patient at every visit.
What ICD 10 code for smoking cessation?
Z71. 6 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM Z71.
Who can bill CPT 99407?
Medicare and most private insurers pay for physicians, NPs and PAs to counsel patients regarding smoking cessation. Medicare waives the co-payment/co-insurance and deductible for this service.
Can 90471 and 99406 be billed together?
If you check the CCI edits, you’ll see that 99406 is a Column 2 code when billed with 90471. You need either a -59 modifer OR one of the X{EPSU} modifiers on 99406 if it is supported by the documentation as a separate service.
How often can you bill 99406?
The 2019 CMS guidelines state that Medicare covers two cessation attempts per 12-month period. Each attempt includes a maximum of up to four intermediate (99406) or intensive (99407) counseling sessions, with a total Medicare benefit of eight sessions per year.
What are the 5a’s in tobacco Counselling process?
The US Preventive Services Task Force (USPSTF) recommends using the 5 As model; ask, advise, assess, assist and arrange.
What is the CPT code for tobacco screening?
for tobacco use screening, the preventive counseling E/M codes are used. Codes 99406 and 99407 are selected according to the time spent counseling the patient regarding tobacco cessation during a face to face visit.
Can 99406 and 99407 be billed together?
99407 is not an add-on code, and the two codes are never reported together. Report only one of the codes, depending on the time of the counseling.
What DX code covers 99406?
CPT code 99406 is used to report for smoking and tobacco cessation counseling requiring three to 10 minutes of time and CPT code 99407 for counseling requiring more than ten minutes.
How do you assess smoking cessation?
Assessment Checklist
- amount smoked.
- degree of dependence (e.g., cigarettes per day, time to first cigarette)
- patterns of smoking.
- reasons for smoking.
- reasons for quitting.
- experience with quitting: what worked and what didn’t.
- previous relapse triggers.
- other addictions, medical problems, psychiatric problems, medications.
How do you document tobacco?
Documentation Tips: ✓ Be as specific as possible when documenting current and past history of nicotine use/dependence. for example, document “quit smoking cigarettes in 2014” or “quit cigars at age 42,” rather than just “quit smoking” or “does not currently use tobacco.”
Who can bill CPT 99406?
Medicare and most private insurers pay for physicians, NPs and PAs to counsel patients regarding smoking cessation.
What best practice interventions would the nurse recommend for tobacco cessation assistance?
Nurses and brief intervention
- Ask about tobacco use.
- Advise the patient to quit.
- Assess readiness to quit.
- Assist the patient in quitting.
- Arrange a follow up to check their status.
What is the ICD 10 code for history of tobacco use?
ICD-10 code Z87. 891 for Personal history of nicotine dependence is a medical classification as listed by WHO under the range – Factors influencing health status and contact with health services .
What interventions are available to aid with smoking cessation?
SORT: KEY RECOMMENDATIONS FOR PRACTICE
| Clinical recommendation (smoking cessation interventions) | Evidence rating | Quit rates at six months (%)* |
|---|---|---|
| Brief physician advice | A | 2 to 10 |
| Telephone counseling | A | 5 to 19 |
| Self-help materials | B | 7 to 27 |
| Nicotine patch | A | 8 to 21 |
What is the CPT code for tobacco use cessation counseling?
99406 – Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes 99407 – Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes A modifier 25 may be appropriate to append to the primary E/M visit code.
How much does smoking cessation counseling cost with Medicare?
Medicare reimbursement for 99407, smoking cessation for longer than 10 minutes of counseling is $28.96. The 10 minute or longer consult may not apply to everyone. The 3 to 10 minute counseling code, 99406, reimburses $15.70.
Does Medicare Part B cover tobacco cessation counseling?
Medicare Part B (provider component) covers two levels of tobacco cessation counseling for symptomatic and asymptomatic patients: intermediate (great than 3 minutes but no more than 10 minutes) and intensive (greater than 10 minutes).
How do I Bill for smoking cessation?
Check with your local Medicare carrier or private insurance company for their rules and requirements before billing for smoking cessation. The documentation in the medical record must support the billing of the cessation code.