Smoking and Tobacco

Question:

Is smoking cessation included in the annual physical exam? If not, can it be billed separately with an E&M code?

Answer:

I assume I'm corresponding with a provider of services, so I'm going to refer you to a Medicare/Medicaid bulletin that covers these areas.  However, let me also briefly outline what can and should be done.

 

1)  Brief counseling -- under 3 minutes is not billable -- but is demonstrably effective.  I suggest to my residents that they ASK everyone if they smoke, ADVISE smokers to quit in no uncertain terms, REFER them to 800-QUIT-NOW and PRESCRIBE for them nicotine replacement, buproprion or verenicline.  I tell my residents to help retire smoking (AARP).

 

2)  If that runs more than 3 minutes, you may bill one of two "G" codes: G0375 for 3-10 minutes, or G0376 for greater than 10 minutes. These can be billed separately or combined with a modifier 25 if a 99211-15 for another E/M is billed on the same visit.

 

For the full technical scoop visit:

 

http://www.cms.hhs.gov/Transmittals/Downloads/R562CP.pdf

 

or

 

http://www.aarc.org/resources/tobacco/MSSmokingCessation.pdf

 

Keep in mind that the premature mortality for continuing smokers is FIFTY PERCENT, and the number one reason people quit is "my doctor told me to."

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Response by:

Rob Crane, MD Clinical Assistant Professor Department of Family Medicine College of Medicine The Ohio State University