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
- Free updates on CPT, ICD-9, HCPCS, Medicare, NCCI edits, and ICD-10.
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