Study frequency guidelines before you bill for counseling services.
Question: A 60-year-old established Medicare patient with a confirmed diagnosis of vanishing lung (emphysema) reports to the family physician (FP) for a medication check and blood work; the patient is a moderate smoker. During the medication check and blood work, which took about 5 minutes, the patient tells the practice’s non-physician practitioner (NPP) “I think I’m ready to quit smoking; can you help?” The NPP spends the next 7 minutes providing smoking cessation counseling for the patient. Can I report a cessation code and an E/M?
Answer: Provided the patient meets Medicare’s requirements for cessation counseling, you can report the following:
- 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician. Usually, the presenting problem[s] are minimal. Typically, 5 minutes or less are spent performing or supervising these services.) for the E/M
- 492.0 (Emphysema; emphysematous bleb) appended to
- 99211 to represent the patient’s emphysema
- 99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) for the smoking cessation counseling
- 305.1 (Tobacco use disorder) appended to 99406 to represent the patient’s tobacco dependency.
Know the rules: According to Medicare, its patients are entitled to smoking and tobacco use cessation counseling provided the patient is either:
- a tobacco user who has an illness caused or complicated by tobacco use or
- taking a therapeutic agent whose metabolism or dosing is affected by tobacco use as based on Food and Drug Administration-approved information.
Additionally, note these two frequency guidelines for spot-on 99406 and 99407 (… intensive, greater than 10 minutes) claims:
- Medicare will cover up to two counseling attempts per year for the first 12-month period of counseling (Each attempt can include up to four counseling sessions).
- Medicare will cover up to eight more sessions during a second or subsequent 12-month period of counseling 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 2009, a second series of eight sessions may begin in April 2010.
@ Family Practice Coding Alert (Editor: Chris Boucher, CPC).
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