Q&A: You’ve got questions! We’ve got answers!
Physician Practice Insider, September 6, 2016
Submit your questions to Associate Editor Nicole Votta at nvotta@hcpro.com and we will work with our experts to provide you with the information you need.
Q: We provide tobacco cessation services and have been reporting these with the following HCPCS codes:
- G0436, smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than three minutes, up to 10 minutes
- G0437, smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes
There are also CPT® codes for these services. Which is the appropriate set of codes to use for Medicare?
A: The HCPCS codes for tobacco cessation were created in 2011 to report the counselling services being provided to Medicare beneficiaries. The CPT codes for these services have slightly different descriptions:
- 99406, smoking and tobacco use cessation counseling visit; intermediate, greater than three minutes up to 10 minutes
- 99407, smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes
As of October 1, 2016, CMS is removing G0436 and G0437 from the I/OCE so they will no longer be processed on outpatient claims.
All of the codes are status indicator S (significant procedure/service). However, it is interesting to note that while G0436 and 99406 are both assigned to APC 5821, G0437 is assigned to APC 5822 and 99407 is assigned to APC 5821. There is a difference in the national unadjusted payment for these APCs: APC 5821 is $27.12, while APC 5822 has a national rate of $69.65. So for sessions lasting longer than 10 minutes, there will be approximately a $42 reduction in reimbursement.
Editor’s note: Denise Williams, RN, CPC-H, senior vice president of revenue integrity services at Revant Solutions, in Fort Lauderdale, Florida, answered this question. This information does not constitute legal advice. Email your questions to Associate Editor Nicole Votta at nvotta@hcpro.com.
Related Products
Most Popular
- Articles
-
- Math can be tricky: TJC corrects ABHR storage requirement
- Air control equals infection control
- Don't forget the three checks in medication administration
- Note similarities and differences between HCPCS, CPT® codes
- Five ways to safeguard your patients' valuables
- Residency coordinators’ responsibilities
- The consequences of an incomplete medical record
- Study: Shorter shifts reduces residents’ attentional failures
- Q&A: Primary, principal, and secondary diagnoses
- OB services: Coding inside and outside of the package
- E-mailed
-
- Air control equals infection control
- OSHA HazCom updates include labeling, SDS requirements
- Plan of Care Supports Documentation of Homebound Status
- Note similarities and differences between HCPCS, CPT® codes
- Note from the instructor: CMS clarifies billing guidelines on proper billing for drugs in a single-dose or single-use vial, including billing for discarded drugs
- Neurological checks for head injuries
- Modifiers and medical necessity
- Fracture coding in ICD-10-CM requires greater specificity
- Follow these tips to properly report bladder catheter codes
- Five ways to safeguard your patients' valuables
- Searched