Do you know that you can bill for a Smoking Cessation Face-to-face encounter? But the question that you may have is how do you bill for Smoking Cessation Counseling?
Here are your codes:
99406 Intermediate Smoking and tobacco use cessation counseling visit is greater than three minutes, but not more than 10 minutes
99407 Intensive Smoking and tobacco use cessation counseling visit is greater than 10 minutes
Diagnosis that Meets Medical Necessity (always refer to your payer's guidelines too!)
F17.200 Nicotine dependence, unspecified, uncomplicated
F17.201 Nicotine dependence, unspecified, in remission
F17.210 Nicotine dependence, cigarettes, uncomplicated
F17.211 Nicotine dependence, cigarettes, in remission
F17.220 Nicotine dependence, chewing tobacco, uncomplicated
F17.221 Nicotine dependence, chewing tobacco, in remission
F17.290 Nicotine dependence, other tobacco product, uncomplicated
F17.291 Nicotine dependence, other tobacco product, in remission
Z87.891 Personal history of nicotine dependence
How do you bill Smoking Cessation code with the EM or Evaluation and Management codes?
Append your Modifier 25 to the E/M Code and not on the Smoking Counselling Code!
Make sure you know the guideline of Modifier 25 and always know how to identify necessity.
Modifier -25, Significant, separately identifiable evaluation and management
service by the same physician on the same day of the procedure or other
This modifier must be appended with an E/M service. This is the modifier you will need to use
with the evaluation and management service done on the same day with other procedure done
by the same physician. It has to be above and beyond the usual preoperative and postoperative
encounter with the procedure. In fact, by using this modifier, it doesn't have to have a different
diagnosis reported. The most important thing is that, the E/M level should meet its key
components or if it is selected based on time with the patient (counseling and coordination). You
have to be careful in using this modifier. It must meet medical necessity. As you know, there are
procedures that already includes all other care and management.
Let's describe this modifier 25:
A patient came in for her monthly follow up for her chronic back pain. At the same time, patient
was complaining with severe headache. The pain doctor performed bilateral occipital block on
the patient at the time of service. You will append modifier 25 for the E/M code to indicate that both
services were rendered on the same day.
You don't use modifier 25 with E/M encounter that resulted to Decision for Surgery (we have
another modifier for this!)
ABOUT THE AUTHOR:
Ms. Pinky Maniri-Pescasio is the Founder of GoHealthcare Consulting. She is a National Speaker on Practice Reimbursement and a Physician Advocate. She has served the Medical Practice Industry for more than 25 years as a Professional Medical Practice Consultant.