Sunday, August 29, 2010

Coding for Smoking Cessation - Info straight from CMS!

Coding Information for SMOKING CESSATION… Info Straight from CMS

Hi to my blog readers... This is just another reminder that CMS now pays for smoking cessation, and that they are committed to helping our patients quit smoking. In addition, these services are billable, (and payable from Medicare) with proper documentation. Please be sure that your providers denote this as "separately identifiable" from your regular E&M visits AND have your time documented of the minutes spent in the smoking/tobacco cessation counseling visit. (time-in/time-out is the best for audit substantiation, but a notation of how much time spent is OK too.)

I've included some websites where this info can be found at the end of the blog.
  • 99406 Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes, up to 10 minutes
  • 99407 Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes
  • Diagnosis code 305.1

CMS smoking cessation guidelines & information:

Smoking is the most preventable cause of disease and death in the U.S. People who continue to smoke after the age of 65 have a higher overall risk of disease and death than those who quit. Smoking contributes to and can exacerbate heart disease, cancer, stroke, lung disease, hypertension, diabetes, osteoporosis, macular degeneration, and cataracts. It can also interfere with the effectiveness of medications that many older adults take, including insulin.

In March 2005, CMS determined that there was sufficient evidence to support Medicare coverage for smoking and tobacco use cessation counseling for beneficiaries who have smoking-related illnesses, or who are taking medications that are affected by tobacco use. Medicare's prescription drug benefit will also cover smoking cessation treatments prescribed by a physician beginning in January 2006.

This section provides information regarding Medicare's smoking and tobacco use cessation counseling benefit, resources to support providers in the delivery of counseling, and organizations promoting cessation to older adults.

General Facts:

• An estimated 9.3% of people ages 65 and older smoke cigarettes.

• Approximately 440,000 people die annually from smoking related diseases, and 300,000 of those deaths occur in people ages 65 and older.

• One study estimated that Medicare spends about 10% of its total annual budget on treating smoking-related illnesses--approximately $24 billion in 2001.

• There are significant benefits to quitting smoking, even after 30 or more years of smoking. Lung function and circulation begin to improve soon after quitting. Smokers who quit have cardiovascular mortality rates similar to those of non-smokers, and this benefit is unrelated to age or the time elapsed since quitting. In one study, older smokers who already had coronary artery disease improved their survival and risk of heart attack by quitting.

• Older adults who smoke have been shown to be more successful at quitting than younger smokers.

What Medicare covers:

Medicare covers 2 types of counseling:

• Intermediate cessation counseling is 3 to 10 minutes per session; and

• Intensive cessation counseling is greater than 10 minutes per session.

Medicare will cover 2 quit attempts per year. Each quit attempt may include a maximum of 4 intermediate or intensive counseling sessions, with the total annual benefit covering up to 8 sessions in a 12-month period. The health care provider and patient have the flexibility to choose between intermediate and intensive counseling.

To be eligible to receive this benefit, a beneficiary must have a condition that is adversely affected by smoking or tobacco use, or that the metabolism or dosing of a medication that is being used to treat a condition the beneficiary has is being adversely affected by his or her smoking or tobacco use.

In addition, Medicare Part D will also cover smoking cessation treatments prescribed by a physician beginning in January 2006. However, over-the-counter treatments, such as nicotine patches or gum, will not be covered.

Other helpful information:

In addition to Medicare's smoking cessation counseling benefit, the Department of Health and Human Services launched a national telephone counseling quit line for all smokers in the U.S. The toll free number 1-800-QUITNOW (1-800-784-8669, TTY 1-800-332-8615) is a single access point to the National Network of Tobacco Cessation Quit lines. Callers are routed to a state-run quit line for assistance. If there is no state-run quit line, they are routed to the National Cancer Institute's quit line.


  1. CPT coding is now available for smoking cessation counseling.

  2. This is such nice post. A plan of action and reference are not nationals of the CMS requirements for reporting advice to quit smoking.

  3. There ae canonical terms and doctor would not concodered thgat kind of conditions.