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Field Guide to Physician Coding 3rd Edition



Smoking cessation codes
Citations: CMS Provider Resources link,
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There are two CPT® smoking cessation codes that replaced CMS's temporary HCPCS codes (99406--99407). These are time based codes.  The first requires up to three minutes of time spent in smoking cessation, and the second 3-10 minutes.  The note must document the patient's tobacco use, the adverse effects the tobacco has on the patient's conditions and the amount of time spent in the counseling.

For Medicare, use the diagnosis code of the patient's condition that is adversely affected by the smoking, such as COPD or heart disease.  Use 305.1 in the second position.

Whenever time is used to define a code, document time in the care.

These codes may be used in addition to an E/M code.  Use modifier 25 if both services are performed and documented.

If a physician sees a patient who has chronic diseases, and over 50% of the total 25 minute time is spent in discussing the patient's disease process, diet, exercise and smoking, select the code based on time and do not add the smoking cessation codes.  It doesn't make sense to add three extra minutes when the base code is based on time.  However, if a physician sees a patient for an acute bronchitis, and documents and selects the code based on the three key components, and in addition, spends an additional 5 minutes in counseling about quitting smoking, then add the second code.

Medicare allows 4 attempts/year, with each attempt consisting of 2 visit tries.  After a period of time passes, the patient is eligible for the services again.  These are per patient allowances, not per physician. The patient's cardiologist and internist may both be billing the codes.

Other payers have their own payment policies.

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