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Beginning March 2005, Medicare Part B began providing coverage for smoking and tobacco-use cessation counseling. Here are some of the most frequently asked questions about billing for this service.
Are all Medicare beneficiaries eligible for smoking cessation counseling?
No. Medicare statute states that coverage is limited to Medicare beneficiaries who use tobacco and have a disease or adverse health effect found by the US Surgeon General to be linked to tobacco use. In addition, it is limited to those taking certain therapeutic agents whose metabolism or dosage is affected by tobacco use as based on FDA-approved information. Additionally, patients must be competent and alert at the time that services are provided.
What codes are used to bill for these services?
Two new codes were added to the Health Care Financing Administration's Common Procedure Coding System:
Smoking and tobacco-use cessation counseling services of 3 minutes or less are bundled into the evaluation and management (E&M) service.
Who can provide these services?
Physicians and qualified nonphysician practitioners can bill Medicare for smoking and tobacco-use cessation counseling.
How often can these codes be used?
Medicare Part B covers two smoking cessation attempts each year. Each attempt may include a maximum of four intermediate or intensive sessions. A total of eight sessions are covered in a 12-month period.
Is special documentation required?
Claims for smoking and tobacco-use cessation counseling should be submitted with a diagnosis code that reflects the condition the patient has that is adversely affected by tobacco use or the condition the patient is being treated for with a therapeutic agent whose metabolism or dosing is affected by tobacco use. Providers should include appropriate documentation in the patient record to adequately demonstrate that Medicare coverage conditions were met for any services provided.
Can an E&M service be provided on the same day as smoking and tobacco-use cessation counseling?
Yes. If an E&M service is provided on the same day as smoking and tobacco-use cessation counseling, providers should choose the appropriate E&M code and use modifier 25 to show that the E&M service is a separately identifiable service from the smoking and tobacco-use cessation counseling service.
Can these codes be used for payers other than Medicare?
Codes G0375 and G0376, and the associated reimbursement policies, were developed specifically for Medicare patients. Other payers may choose to recognize these codes for non-Medicare patients, but they are not required to do so. Check with your payers for their policy on coverage and reimbursement for smoking and tobacco-use cessation counseling.
Changes in the 2007 ICD-9-CM (The International Classification of Diseases, Ninth Revision, Clinical Modification) manual include new codes, revisions, and deleted codes frequently used by oncology and hematology practices. Table 1 summarizes many of these changes. For a complete list, refer to the 2007 ICD-9-CM manual. Changes in ICD-9-CM were effective October 1, 2006.