Late last month, Dr. Brenda Fitzgerald, Director of the Centers for Disease Control and Prevention, announced her resignation in response to a Politico report exposing an unethical conflict of interest between Fitzgerald and the tobacco industry. The report reveals that the Trump administration’s top public health official purchased shares in Japan Tobacco, an organization that is responsible for the sales of four major tobacco brands after she had accepted her role as CDC director. The ethical implication of these purchases fell under heavy scrutiny at the hands of Richard Painter, who pointed out the disappointing irony behind the CDC’s efforts to prevent tobacco related diseases, and the director’s decision to exploit the market.

Considering these decisions, we thought it was important to note that tobacco has often been referred to as the number-one preventable cause of disease – one that many physician offices are working to combat through Tobacco Cessation Counseling. As the popularity of this treatment grows, proper documentation will become more integral than ever.

Since the 2014 Patient Protection and Affordable Care Act (ACA), physicians can be reimbursed for the preventative services of tobacco use screening and cessation counseling. It is a well-known fact that smoking has negative effects on your health, but did you know that if you require surgery while maintaining your smoking habit, that the risk of complications rises and recovery becomes more difficult? Smoking cessation can be a very difficult thing to do, and most of the time, it does not happen overnight. A physician will have many opportunities to counsel patients on smoking cessation. For Medicare patients, they can have up to eight smoking cessation counseling sessions per year, including four intermediate or intensive sessions, and two cessation attempts.

The two CPT codes to use for smoking cessation are:

  • 99406, Intermediate Counseling, Smoking and tobacco use cessation counseling visit is greater than three minutes, but not more than 10 minutes
  • 99407, Intensive Counseling, Smoking and tobacco use cessation counseling visit is greater than 10 minutes

The HCPCS codes G0436 and G0437 were part of coding for smoking and tobacco cessation counseling, and were used for asymptomatic patients. As of October 1, 2016 the two HCPCS codes, G0436 and G0437 were deleted, because Medicare no longer recognizes a difference between symptomatic and asymptomatic patients.

As you can see these are time-based codes, so the service should be documented to include the total time spent face-to-face with the patient, including what was discussed. During your review, make sure the provider has met medical necessity requirements by documenting that the patient uses tobacco, whether or not if there are signs or symptoms, with the service should be documented by a qualified physician. The documentation also must verify that smoking/tobacco counseling was performed.

The five “A’s” of intervention can be used to determine this:

  1. Asked about tobacco use
  2. Advised to quit
  3. Assessed for the willingness to attempt to quit
  4. Assisted with the attempt to quit
  5. Arrange to follow up with the patient

Without this supplementary documentation, the payment for the smoking cessation counseling can be included in the E/M service. Don’t forget your appropriate ICD-10 code(s) to support the medical necessity as well. When documented, your ICD-10 code(s) should include one for tobacco use status and one for confirmed tobacco-related diseases.

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