Tobacco cessation question

Hello



Do the guidelines below only apply to hospitals or MD offices as well?



October 2016 Update of the Hospital Outpatient Prospective Payment System (OPPS)



"Effective September 30, 2016, HCPCS codes G0436 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) and G0437 (Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes) are deleted. The services previously represented by HCPCS codes G0436 and G0437 should be billed under existing CPT codes 99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) and 99407 (Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes) respectively. See table 2, attachment A."



Thanks



Beth


Beth Aldridge, CPC
Coding Manager

Northern California Medical Associates, Inc
Phone: (707) 573-6145
Fax: (707) 573-6932

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Comments

  • I believe it only applies to hospitals - but I am not sure
    Don


    Don Self & Associates, Inc

    305 Senter Ave, Whitehouse, TX 75791
    903 871-1172 fax 480-247-5650
    donself@donself.com web: www.donself.com
    free webinars at www.donself.com

    DISCLAIMER: This email has not been scanned for correct spelling, grammar or punctuation. It has been created in the language of Texan and may or may not be understood completely to those north of Kentucky.

  • Hope everyone else has had better luck than I have. I have not gotten payment from our Medicare carrier for the first one of these. ALWAYS not medically necessary. I am using the dx they specify in Medlearn but does not appear to make a difference what dx is used. Is anyone getting paid for these by Medicare??? This is a TN provider/Cahaba.



    DIANA FRANKLIN, CMRS, CPC

    Member American Medical Billing Association

    Member American Academy of Professional Coders

    (931) 879-9854

    dianaf@twlakes.net



  • great catch. I stand corrected. Thanks Erica!

    Don


    Don Self & Associates, Inc

    305 Senter Ave, Whitehouse, TX 75791
    903 871-1172 fax 480-247-5650
    donself@donself.com web: www.donself.com
    free webinars at www.donself.com

    DISCLAIMER: This email has not been scanned for correct spelling, grammar or punctuation. It has been created in the language of Texan and may or may not be understood completely to those north of Kentucky.

    On Oct 12, 2016, at 9:32 AM, Erica Schwalm wrote:

    MDs also

    https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R1672OTN.pdf
  • We bill this often – we code it as 99406 (or 99407). For the dx we use F17.210 and Z72.6. Usually Medicare does pay (Cahaba). The documentation is vital though.



    Thanks

    Deborah Broyles, CPC
    Supervisor/Coding Specialist
    University Radiation Oncology/University Surgical Oncology
    865-305-9886 phone / 865-305-9714 Fax

  • Oops – I meant Z72.0



    Thanks

    Deborah Broyles, CPC
    Supervisor/Coding Specialist
    University Radiation Oncology/University Surgical Oncology
    865-305-9886 phone / 865-305-9714 Fax

    Notice & Disclaimer: The information given in this email is intended as generalized coding guidance and should not be misinterpreted as medical, health, legal or financial advice. Furthermore, it is the responsibility of the provider to code services as they are documented in the permanent medical record following federal and state regulations, as well as carrier specific guidelines. Any information given should not be modified in any way, sold for profit or shared without the express permission of UPA. While all information given is thoroughly researched and believed to be correct, recipients of this email accept responsibility for their own coding and documentation.

  • Ok – sorry all --- I should have read my response better. We bill the 99406 and 99407 to Medicare (Cahaba) with dx of F17.210 and Z71.6. We usually do get paid. Physicians need to document the counseling correctly.



    Thanks

    Deborah Broyles, CPC
    Supervisor/Coding Specialist
    University Radiation Oncology/University Surgical Oncology
    865-305-9886 phone / 865-305-9714 Fax

  • The link is very helpful, thanks

    Beth Aldridge, CPC

    Coding Manager



    Northern California Medical Associates, Inc

    Phone: (707) 573-6145

    Fax: (707) 573-6932



  • edited May 2017
    Medicare will pay with the appropriate code pair. You need one of the primary dx codes for nicotine dependence and a secondary dx code. To get the list, go to the NCD at the link below. In the Revision history, download the zip file called TN 1199. Once you open that, open the 3rd file down CR-897 210.4 Smoking Tobacco spreadsheet and click on the first tab.

    https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=342&ncdver=1&DocID=210.4.1&ncd_id=210.4.1&ncd_version=1&basket=ncd%3A210%2E4%2E1%3A1%3ACounseling+to+Prevent+Tobacco+Use&bc=gAAAAAgAAAAAAA==&



  • We are Noridian. We used to get paid for tobacco cessation with no problem, but the last couple of months we have been getting medical necessity denials. We have tried multiple code combinations unsuccessfully.

    Beth

    Beth Aldridge, CPC
    Coding Manager

    Northern California Medical Associates, Inc
    Phone: (707) 573-6145
    Fax: (707) 573-6932

  • We have never charged this but our physicians want us to. Can someone give me an example of acceptable documentation to support this? They want to just list the CPT code with the descriptor and a statement that “discussed the benefits of quitting smoking.” We have WPS.

    Would that be sufficient documentation to charge?

    Thanks!


    Laurie Johnson
    Laurie Johnson, CCS, COC
    Certified Coder
    Hannibal Regional Healthcare System
    573-248-5421 (O)
    Laurie.johnson@hrhonline.org



  • edited May 2017
    No, these are time based codes so the time spent and nature of counseling must be documented.

  • The actual time spent- not just the range of time as reflected in the code descriptor correct?

  • edited May 2017
    Correct

  • Thank you. I have download that and saved. Will send one more claim and see what happens before I call them again. I did not realize the primary dx were so limited. I think a lot of our were billed with z17.298

    DIANA FRANKLIN, CMRS, CPC
    Member American Medical Billing Association
    Member American Academy of Professional Coders
    (931) 879-9854
    dianaf@twlakes.net

    Confidentiality Notice: Confidential Health Information Enclosed
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  • Thanks. Unfortunately, we have tried coding using either Z72.0 or various codes from the F17.2 dependence family as the primary diagnosis. We have used codes from the approved list (sinusitis, COPD, etc.) as the secondary diagnosis, still denies.

    Beth Aldridge, CPC

    Coding Manager



    Northern California Medical Associates, Inc

    Phone: (707) 573-6145

    Fax: (707) 573-6932



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