Smoking cessation: How to code for reimbursement

Finally, there's some good news about smoking--cessation, that is. According to a recent piece in American Medical News, providers who spend more than three minutes in a patient encounter, providing counseling on how to quit smoking, are indeed able to get paid for that service.

Whether looking to receive reimbursement from Medicare, private insurance, or through bonuses tied to quality metrics, practices' first step is to identify which patients are smokers and then flag the chart using either a sticker (for paper) or an electronic alert. Next, providers must document patients' answers to questions about tobacco cessation, such as what quit methods they've previously attempted and whether a smoking-cessation drug or nicotine replacement would be appropriate. The patient's chart should also include an estimate of the time spent discussing tobacco dependence and cessation.

Coverage and payments will vary among Medicare and private payers. Here is how the coding differs by situation:

  • Patients without tobacco-related illness--ICD-9 codes 305.1, nondependent tobacco use disorder, or V15.82, history of tobacco use
  • Medicare patients receiving three to 10 minutes of counseling--G0436
  • Medicare patients receiving more than 10 minutes of counseling--G0437
  • Private insurance short-visit CPT code--99406
  • Private insurance longer-visit code--99407
  • If evaluation and management codes characterize the focus of the visit, use modifier 25

To learn more:
- read this article in American Medical News