Preventive Service: G0436, G0437 Close Your Asymptomatic Tobacco Use Preventive Counseling Coding

James Smith
January 3, 2012 — 1,826 views  
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Reserve codes 99406-99407 for symptomatic counselling claims. 

After an asymptomatic Medicare patient who uses tobacco comes to your office, ensure that you're reporting expanded smoking and tobacco-use cessation counseling codes -- G0436 and G0437 -- to ethically recoup documented counseling time.

Check out some medical coding tips on what you need to know to code and bill for these services: 

Don't Oversee Cessation Counselling Waiver

 

  • G0436 – (Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes)
  • G0437 – (Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 10 minutes.)

 

CMS has created these two novel G codes for billing for tobacco cessation counseling services to stop tobacco use for dates of service on or after January 1, 2011. These are in addition to the two CPT codes 99406 and 99407 that at present are brought in use for tobacco cessation counseling for symptomatic individuals. Medicare will give up the deductible and coinsurance/copayment meant for counseling and billing with these two novel G codes on or after January 1, 2011.

CMS will permit two individual tobacco cessation counselling attempts for every year. Every attempt may comprise a maximum of four intermediate (more than 3 minutes up to 10 minutes) OR intensive sessions (more than 10 minutes), with an aggregate benefit covering up to 8 sessions for every year per Medicare beneficiary who uses tobacco. This policy is steady for all service codes i.e. G-codes and standard CPT codes

3-minute cut off: You must include counseling that continues up to three minutes in reimbursement meant for the standard evaluation and management (E/M) office visit (99201-99215, Office or other outpatient visit for the evaluation and management of a new patient...). In case the counseling goes beyond three minutes, you must report G0436 or G0437. 

ICD-9 connection: Ensure you link the G code to ICD-9 305.1 (Nondependent abuse of drugs; tobacco use disorder) or V15.82 (Personal history of tobacco use) for the patients who are asymptomatic for tobacco related diseases.

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James Smith


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