Coding for Smoking Cessation and Obesity Counseling

Changing patient behaviors isn't easy. Changing any behavior - one's own or someone else's - isn't easy. It takes more than willpower and sideline cheering. Support and advice from a trusted adviser can help patients to adopt healthier lifestyles. Medicare and many private payers will pay medical practices a small fee for smoking cessation counseling and intensive behavioral therapy (IBT) for obesity behavior modification.

There are two sets of codes for smoking cessation (CPT and HCPCS) and one HCPCS code for IBT. All of them are time-based codes, which means time must be documented in the medical record in addition to describing the content of the counseling. It isn't enough to select the code in the order entry that has the time listed. In the body of the note, the clinician must document the time of the counseling.

The CPT codes for smoking cessation (99406 and 99407) are used for all payers for patients who are symptomatic as a result of smoking. In addition to the diagnosis code for tobacco use, add additional diagnosis codes that describe the adverse effects from tobacco use, such as atherosclerosis or chronic obstructive bronchitis.  The HCPCS codes for smoking cessation counseling (G0436 and G0437) are used for patients who are asymptomatic at the current time. For those patients, use only the tobacco abuse diagnosis code. For both, document the advice that was given, the options discussed, and the treatment plan. Any specialty provider may perform and report these services. However, there are frequency limits for 99406 and 99407 by patient, not provider. CMS will pay for two attempts each year, up to eight face-to-face visits in a 12-month period. CMS's MLN Matters article MM7133 provides additional detail.

Medicare pays for intensive behavioral therapy (IBT) for beneficiaries with a body mass index of 30 or greater. This service may be performed by a primary-care physician, OB/GYN physician, nurse practitioner, physician assistant, or certified clinical nurse specialist. In CMS's decision memo to support covering the service, they said the service may be performed incident-to a physician service by ancillary personnel.

"In the primary-care office setting, Medicare may cover these services when billed by the primary-care physician or practitioner and furnished by auxiliary personnel under the conditions specified under our regulation at 42 CFR section 410.26(b) (conditions for services and supplies incident to a physician's professional service)."

The benefit includes:

• One face-to-face visit every week for the first month;

• One face-to-face visit every other week for months 2-6; and

• One face-to-face visit every month for months 7-12, if the beneficiary meets the 3 kg weight loss requirement during the first six months.

The Medicare copay and deductible are waived for this service. More detailed information is in the MLN Matters article MM7641 on CMS's website.

These services may be provided on the same day as an E&M service or a wellness visit (for Medicare patients) but the time of the counseling must be distinct from the other E&M service. Be sure to document time and the nature of the counseling in the note.

The CPT/HCPCS codes

99406 Smoking cessation counseling for symptomatic patient 3-10 minutes

wRVU .24 Total non-facility RVU .38

99407 Smoking cessation counseling for symptomatic patient greater than 10 minutes

wRVU .5 Total non-facility RVU .77

G0436 Smoking cessation counseling for asymptomatic patient 3-10 minutes

wRVU .24 Total non-facility RVU .40

G0437 Smoking cessation counseling for asymptomatic patient greater than 10 minutes

wRVU .5 Total non-facility RVU .79

G0447 Face-to-face behavioral counseling for obesity, 15 minutes

wRVU .45 Total non-facility RVU .73

Diagnosis codes

ICD-9 Tobacco abuse 305.1

ICD-10 Nicotine dependence

F17 Nicotine dependence

 F17.2 Nicotine dependence

 F17.20Nicotine dependence, unspecified

 F17.200 …… uncomplicated

 F17.201 …… in remission

 F17.203Nicotine dependence unspecified, with withdrawal

 F17.208 …… with other nicotine-induced disorders

 F17.209 …… with unspecified nicotine-induced disorders

 F17.21Nicotine dependence, cigarettes

 F17.210 …… uncomplicated

 F17.211 …… in remission

 F17.213 …… with withdrawal

 F17.218 …… with other nicotine-induced disorders

 F17.219 …… with unspecified nicotine-induced disorders

 F17.22Nicotine dependence, chewing tobacco

 F17.220 …… uncomplicated

 F17.221 …… in remission

 F17.223 …… with withdrawal

 F17.228 …… with other nicotine-induced disorders

 F17.229 …… with unspecified nicotine-induced disorders

 F17.29Nicotine dependence, other tobacco product

 F17.290 …… uncomplicated

 F17.291 …… in remission

 F17.293 …… with withdrawal

 F17.298 …… with other nicotine-induced disorders

 F17.299 …… with unspecified nicotine-induced disorders