Coding Corner: Tobacco Cessation Counseling Coding | Allison Barrie, MD

Allison Barrie, MD

Since 2010, CMS covers tobacco cessation counseling for outpatient Medicare beneficiaries:

• Who use tobacco, regardless of whether or not they have signs or symptoms
• Who are competent and alert at the time that counseling is provided
• Whose counseling is furnished by a qualified physician or other Medicare-recognized practitioner

Tobacco cessation coding can be added to any outpatient evaluation and management (E/M) visit. Any E/M services provided on the same day must be distinct and separately identifiable. Code 99406 (wRVU 0.24) is used for smoking and tobacco-use cessation counseling visit; intermediate, greater than three minutes and up to 10 minutes. Code 99407 (wRVU 0.50) is used for smoking and tobacco-use cessation counseling visit; intensive, greater than 10 minutes.

For all tobacco cessation services, total time spent on cessation counseling must be documented in the patient’s record with additional other key components. Required documentation includes:

• the patient’s tobacco use, i.e., dependence, type of tobacco used
• time spent in cessation counseling
• that the patient was advised to quit, and the impact of tobacco products use was discussed
• the patient’s willingness to stop use

For intensive visits (99407), additional documentation should include offer of medication management/smoking cessation drugs, resources provided to the patient, setting a quit date, and follow-up arrangements. If capturing the E/M code based on time, please ensure the time spent providing the smoking cessation counseling is not included in the time for E/M service.

Your diagnostic codes will vary based on who is being counseled. Examples include:

• F17.210 Nicotine dependence, cigarettes uncomplicated
• F17.220 Nicotine dependence, chewing tobacco, uncomplicated
• T65.224A Toxic effect of tobacco cigarettes, undetermined

Scenario 1: New patient consult for squamous cell carcinoma of the vulva. You spend time obtaining the patient history, performing an exam, reviewing outside records, imaging, and laboratory values. During this visit, the patient shares that she smokes one pack of cigarettes daily. She is not interested in quitting at this time. You spend 4 minutes discussing smoking cessation resources with the patient. In addition to your E/M code for the new patient visit (99204-99204), you may use the 99406 code for 3-10 minutes of smoking cessation counseling.

Scenario 2: Return patient visit for surveillance for endometrial cancer. The patient is an everyday cigarette smoker and shares with you today that she is interested in quitting. You spend 12 minutes discussing this with the patient, reviewing potential quitting aids and medications, as well as resources for counseling support groups within your hospital system. You plan to revisit this issue in three months. In addition to your E/M code for the cancer surveillance visit, you may use the 99407 code for greater than 10 minutes of smoking cessation counseling.

Allison Barrie, MD, is a gynecologic oncologist at Virginia Mason Medical Center in Seattle, WA.