icd 10 code s for procedure 99406

HCPCS/CPT Codes 99406 – Smoking and tobacco-use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes 99407 – Smoking and tobacco-use cessation counseling visit; intensive, greater than 10 minutes ICD-10 Codes

Full Answer

Is smoking cessation counseling reimbursable under E&M code 99381?

If the physician performs a comprehensive preventative medicine evaluation for new patients (99381-99387) or established patients (99391-99397), the smoking cessation counseling is included within the scope of the service.  Use of modifier 25 is required on the E&M code to identify smoking cessation counseling as a separately reimbursable service.

Can I use E/M codes 99406-99407?

• If the provider uses time-based E/M codes to provide counseling services, 99406-99407 may notbe added since E/M service includes counseling. • Only use codes 99406-99407 when counseling is provided to the person being counseled (e.g., pediatric patient).

When to use the 99401-99404 number for pediatric patient health cases?

If screening is the only service being provided, use 99401-99404 (individual) or 99411-99412 (group). Pediatric Patient Pediatric Patient Health Case Scenarios 1. Tobacco cessation counseling provided to a pediatric patient who smokes cigarettes (uncomplicated):

What is the cost of a 99406 session?

99406 ($15.50-$17.06) 99391: ≤ 1 year, established patient 99392: 1-4 years, established patient 99393: 5-11 years, established patient 99394: 12-17 years, established patient 99395: 18-39 years, established patient 99201-99205: New patient 99211-99215: Established patient Individual session 99406 (Fee schedules vary)

Does Medicare pay for CPT code 99406?

These are in addition to the two CPT codes 99406 and 99407 that currently are used for tobacco cessation counseling for symptomatic individuals. Medicare will waive the deductible and coinsurance/copayment for counseling and billing with these two new G codes on or after January 1, 2011.

What is the diagnosis code for smoking cessation?

Z71. 6 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM Z71.

How many times can 99406 be billed?

The 2019 CMS guidelines state that Medicare covers two cessation attempts per 12-month period. Each attempt includes a maximum of up to four intermediate (99406) or intensive (99407) counseling sessions, with a total Medicare benefit of eight sessions per year.

Do you need a modifier for 99406?

Magnolia Health (MH) indicates that 99406 and 99407 are reimbursed with no modifier or diagnosis limitations. The codes are payable on the physician side, but are not covered for outpatient facility claims.

What is the ICD-10 code for F17 210?

F17. 210 Nicotine dependence, cigarettes, uncomplicated - ICD-10-CM Diagnosis Codes.

What is the CPT code for smoking cessation for Medicare?

CMS has advised its Medicare contractors to replace code G0436 with CPT code 99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) and replace code G0437 with CPT code 99407 (Smoking and tobacco use cessation counseling visit; intensive, greater than 10 ...

Who can bill CPT code 99406?

Medicare and most private insurers pay for physicians, NPs and PAs to counsel patients regarding smoking cessation. Medicare waives the co-payment/co-insurance and deductible for this service.

Can 99406 be billed as telehealth?

Medicare patients can access telehealth from their homes (also known as originating site requirements). Previously, patients could only access telehealth from a provider office. Tobacco cessation counseling (CPT codes: 99406 and 99407) can be conducted via audio-only interaction.

Can 90471 and 99406 be billed together?

If you check the CCI edits, you'll see that 99406 is a Column 2 code when billed with 90471. You need either a -59 modifer OR one of the X{EPSU} modifiers on 99406 if it is supported by the documentation as a separate service.

What is smoking cessation?

To quit smoking. Smoking cessation lowers the risk of cancer and other serious health problems. Counseling, behavior therapy, medicines, and nicotine-containing products, such as nicotine patches, gum, lozenges, inhalers, and nasal sprays, may be used to help a person quit smoking.

What is the CPT code for tobacco screening?

for tobacco use screening, the preventive counseling E/M codes are used. Codes 99406 and 99407 are selected according to the time spent counseling the patient regarding tobacco cessation during a face to face visit.

What is modifier 25 in CPT coding?

Modifier 25 is used to facilitate billing of E/M services on the day of a procedure for which separate payment may be made. It is used to report a significant, separately identifiable E/M service by the same physician on the day of a procedure.

What is the ICD-10 code for smoking?

Nicotine dependence, cigarettes, uncomplicated F17. 210 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM F17. 210 became effective on October 1, 2021.

What is the ICD-10 code for personal history of smoking?

Z87.891ICD-10 code Z87. 891 for Personal history of nicotine dependence is a medical classification as listed by WHO under the range - Factors influencing health status and contact with health services .

Is G0436 a valid CPT code?

1, CMS will no longer consider valid for Medicare purposes CPT codes G0436 (Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes) and G0437 (Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than ...

What is smoking cessation?

To quit smoking. Smoking cessation lowers the risk of cancer and other serious health problems. Counseling, behavior therapy, medicines, and nicotine-containing products, such as nicotine patches, gum, lozenges, inhalers, and nasal sprays, may be used to help a person quit smoking.

How long is a 99406?

• 99406: Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes#N# • 99407: Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes

What is the CPT code for smoking cessation?

Effective for services on or after January 1, 2008, you must bill for smoking and tobacco use cessation counseling services with new CPT codes (99406 or 99407) . If you bill using the former HCPCS codes (G0375 and G0376) for services provided after December 31, 2007, your claims will not be paid.

What should a diagnosis code reflect?

Diagnosis codes should reflect ƒ the condition the patient has that is adversely affected by tobacco us, or ƒ the condition the patient is being treated for with a therapeutic agent whose metabolism or dosing is affected by tobacco use. Deductible and coinsurance will apply in a standard medical benefit.

What is the diagnosis code for E/M counseling?

These services are reported using CPT-4 code 99406 (intermediate, E/M counseling service) or code 99407 (intensive, E/M counseling service). The diagnosis code should reflect the condition the patient has that is adversely affected by tobacco use or the condition the patient is being treated for with a therapeutic agent whose metabolism or dosing is affected by tobacco use.

What is Medicare denied for 99406?

Medicare denied all 99406 ( Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) codes with my e/m code. I stated the diagnosis code

How many cessation codes does Medicare pay?

Medicare will only pay a total of 8 cessation counseling codes (99406 or 99407) per year; not per provider. If other providers have also billed for cessation your patient could have hit the maximum for the year.