Easy Counseling Codes Acceptance With Distinct Dxs

By Author: Nancy Rose
Total Articles: 53
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Study frequency guidelines prior to billing for counseling services.


Question: A sixty year old established Medicare patients with a confirmed diagnosis of vanishing lung (emphysema) reports to the family physician for a medication check and blood work; the patient is a moderate smoker. During the medication check and blood work, which took about five minutes time, the patient tells the practice's non-physician practitioner (NPP) I think I am all set to leave smoking; can you help me here?


The NPP spends the next seven minutes providing smoking cessation counseling for the patient. Can I go for a cessation code and an evaluation/management?


Answer: You can go for the following, provided the patient meets Medicare's requirements for cessation counseling:


99211 (Office or other outpatient visit for thee/M of an established patient, that may not require the presence of a doctor. Normally, the presenting problem[s] are minimal. Typically, five minutes or less are spent carrying out or supervising ...
... these services.) for the Evaluation/Management
492.0 (Emphysema; emphysematous bleb) appended to
99211 to represent the patient's emphysema
99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater than three minutes up to 10 minutes) for the smoking cessation counseling
305.1 (Tobacco use disorder) appended to 99406 to represent the patient's tobacco dependency.


You should know the rules: As per Medicare rules, its patients are entitled to smoking and tobacco use cessation counseling //aconsidering the patient is either:
Medicare will cover up to two counseling attempts a year for the first 12-month period of counseling (each attempt can cover up to four sessions.)
Medicare will cover up to eight sessions during a second or subsequent 12-month period of counseling after 11 months have passed since the first Medicare covered cessation counseling session was carried out. For instance, if the first of eight covered sessions was carried out in April last year, a second series of eight sessions may start in April 2010.