Smoking Cessation Billing
Healthcare providers perform smoking cessation (tobacco use) counseling daily, but it is not necessary they may be documenting or reporting it appropriately. Guidance is needed to ensure all performed services are claimed and supported by complete documentation.
The Centers for Medicare & Medicaid Services (CMS) set a standard for coverage which commercial payers might not follow.
CMS will cover tobacco cessation counseling for beneficiaries, per MLN Matters(R) article MM7133,
- Who use tobacco (regardless of whether they have signs or symptoms of tobacco-related disease);
- Who are competent and alert at the time counseling is provided; and
- Who receive counseling furnished by a qualified physician or other Medicare-recognized practitioner.
Each payer may have its own restrictions for coverage, so inquire about a patient?s benefits prior to claim submission.
Documentation must include sufficient detail to support the claim, as with any time-based evaluation and management (E/M) service. Proper documentation for tobacco-use cessation counseling should include the total time spent face to face with the patient, and what was discussed. The patient?s desire or need to quit tobacco use, cessation techniques and resources, estimated quit date, and planned follow up should be noted within the patient?s medical record. Without this information, medical necessity for coverage may be questioned, which could result in denied or delayed payment.
Without documentation of significant and separately identifiable work, the payment for smoking cessation counseling may be included in the payment for the primary E/M service.
Private payers may follow CMS? direction when it comes to billing requirements for these services; however, it?s important to know the patient?s insurance benefits.
Medicare will cover two cessation attempts per year. Each attempt may include a maximum of four intermediate or intensive counseling sessions.
The total annual benefit covers up to eight smoking and tobacco-use cessation counseling sessions in a 12-month period. The beneficiary may receive another eight counseling sessions during a second or subsequent year after 11 months have passed since the first Medicare covered cessation counseling session was performed.
It?s best to verify coverage criteria prior to claim submission.