CMS coding and documentation guidelines: Smoking and tobacco use cessation counseling services

Centers for Medicare and Medicaid Services (CMS) has defined two CPT codes for documenting and billing tobacco use cessation counseling services.

CPT codes to identify tobacco use counseling:

99406 Smoking and tobacco use cessation counseling visit; intermediate, greater than three minutes up to 10 minutes.
99407 Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes.

Use codes 99406 and 99407 appropriately

A cessation counseling session refers to face-to-face patient contact. Remember, a counseling session of three minutes or less is included in the evaluation and management (E&M) payment and is not separately reported or payable.

Billing of E&M service with tobacco counseling

When clinically necessary, E&M services are allowed on the same day as smoking and tobacco use cessation counseling. In order for E&M services to be billed with a tobacco counseling code, the services must be separate and identifiable or distinct. A 25 modifier is appended to the appropriate E&M code.

Diagnosis codes identified with tobacco counseling CPTs

Diagnosis codes need to reflect the patient's condition that is adversely affected by tobacco use. Conditions that may be affected include diabetes, pregnancy or COPD.

Documentation requirements for use of tobacco counseling CPTs

Counseling time and details must be documented. Examples of documentation details include risks, programs/methods for quitting, impact on health and medication and interventions.

In addition, documentation should identify sufficient patient history to adequately demonstrate coverage conditions were met.

Topics: Billing