Physician Practice

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.

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