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BCBS – New Reimbursement Guidelines for Smoking Cessation effective from September 26, 2019

Posted on May 18, 2020 by CPC Exam Medical Coding Updates

Effective September 26, 2019, Horizon BCBSNJ will change the way consider certain professional claims for smoking cessation services provided September 26, 2019.

In accordance with CMS guidelines, Horizon BCBSNJ shall consider for reimbursement smoking and tobacco cessation counseling visits (99406 or 99407) for asymptomatic patients when billed with an approved diagnosis code.

Approved Diagnosis Codes:

Nicotine dependence (F17.21-F17.299)
Personal history of nicotine dependence (Z87.891)
Initial encounter, toxic effect of tobacco and nicotine (T65.211A, T65.212A, T65.213A, T65.214A, T65.221A, T65.222A, T65.223A, T65.224A, T65.291A, T65.292A, T65.293A, T65.294A)

Evaluation and management (E&M) services shall be considered for reimbursement on the same day as smoking and tobacco-use cessation counseling services (99406 or 99407) only when medically necessary, as indicated by appending Modifier 25 to the E&M service.

Limitation:

Horizon BCBSNJ shall limit smoking and tobacco-use cessation counseling (99406 or 99407) in any combination to eight times within a one-year period.

Reference:BCBSNJ

Coding Ahead

Asthma and smoking for Pediatrics

Posted on May 17, 2019 by CPC Exam Medical Coding Updates

We are now getting denials from the Medicaid’s requesting an additional code for "exposure to smoking". We have patients that are not exposed to smoking and still have asthma. We have to appeal each one of these claims with office notes. Does anyone know of a code we can use for "no exposure to smoking" so we can get the claim paid without all the extra appeals, etc?

Thanks in advance!

Medical Billing and Coding Forum

Billing smoking cessation counseling with E&M and EKG

Posted on May 4, 2019 by CPC Exam Medical Coding Updates

My cardiologists have recently started billing the tobacco cessation counseling codes 99406 and 99407. I know when billing these codes with a separate E&M, we need the 25 modifier on the E&M. Sometimes, an EKG 93000 is also done. My question is, do we need a 59 modifier on the EKG when billing all three codes together? I’ve found one online source that specifically says we do need the 59 in this scenario, but nothing else addressing billing the three services on the same date by the same doctor. Any help with this would be appreciated!

Medical Billing and Coding Forum

Hx of Smoking in pregnancy

Posted on February 1, 2019 by CPC Exam Medical Coding Updates

Good afternoon,
I am having a senior moment… lol if a mom is coming in for delivery and she has a 3 year history stopped smoking. I code the Z code only? and if they are coming in for delivery and they quit smoking 7 month’s ago I use the Z history code and the O99.. pregnancy code?

I am going crazy with this any help is greatly appreciated.

New to OB delivery coding don’t know if I can do it….

Medical Billing and Coding Forum

Smoking Cessation billing

Posted on January 29, 2019 by CPC Exam Medical Coding Updates

Hi!

I’m hoping some of you have experience with billing and reimbursement for CPT 99406/99407 smoking cessation counseling. We are an internal medicine practice (pcp) and are looking for some guidance on billing requirements. I read that Medicare covers 8 cessation counseling sessions per year (not per provider) so that part I understand.

When are we allowed to bill for it? Can it be billed at the same time as a annual physical (for non Medicare) or at the same time as a Medicare Wellness visit G0438/G0439? Do we just need to add modifier 25 to the E/M?

I would greatly appreciate any feedback. THANKS!!

Medical Billing and Coding Forum

CPT code for the testing of smoking

Posted on October 3, 2018 by CPC Exam Medical Coding Updates

Hi everyone,

We have a new doctor with our practice that would like to use a hand held machine that a patient would breath into to test for smoking. Is there a CPT code for the testing?

Thanks- Lorie

Medical Billing and Coding Forum

Smoking cessation-HELP!!!!!

Posted on February 24, 2018 by CPC Exam Medical Coding Updates

Hi all! Does anyone know if CPT 99407-Smoking and tobacco use cessation counseling visit can be billed by a Psychologist? The code psychologists used to report was S9075, but it has now expired and according to Optum encoder, the crosswalk is now 99407. Unfortunately, 99407 falls under the E&M section and psychologists can’t report E&M’s. Is there an alternative code, or is it okay to report 99407 since S9075 is crosswalking to that code?

S9075 Smoking cessation treatment
99407 Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes

Medical Billing and Coding Forum