Recently we reached an important healthcare milestone: the fiftieth anniversary of the first Surgeon General's report on smoking. The current acting Surgeon General Boris Lushniak, MD, MPH made an announcement at the White House of new findings enclosed in The Health Consequences of Smoking — 50 Years of Progress.
There is both good news and bad news:
Since that original report, cigarette smoking rates for American adults have dropped significantly. 2012 figures indicate smoking has decreased from 42% in 1964 to 18% as in 2012.
Unfortunately that still equals almost 42 million people and it does not include the approximately 3.5 million middle and high school students.
New evidence has causally implicated smoking as being linked to: rheumatoid arthritis, immune dysfunction, tuberculosis, colorectal cancer, liver cancer, age-related macular degeneration, and erectile dysfunction. Among some of the most important information to come out in this latest report provides research data that indicates:
Active smokers have a 30% to 40% higher risk of developing Type 2 Diabetes compared with nonsmokers
Orofacial clefts in the infants of women who smoke during pregnancy
Strokes can result from secondhand smoke
All in all, it’s the same message, tobacco use is bad, but what do we do about it?
Humans have “free will” they can choose to do things that are bad for them and often do. As healthcare professionals, there is the assumed responsibility to assist patients in making the best choices for their long term wellbeing.
Ask patients if they use tobacco products, encourage them to stop, take an active role in the cessation process and provide medications that can assist in the process.
More good news:
Thanks to the provisions in the Affordable Care Act (ACA) which ensures basic preventive services, all marketplace plans, Medicare, Medicaid and many other plans are required to cover tobacco use counseling and cessation services.
Additionally, these services are covered at 100% by the health plan as they are not subject to copayment, coinsurance or deductible. The financial burden for patients needing cessation services has been removed.
For details on these and other preventive services covered under the Healthcare Marketplace plans, go to www.healthcare.gov.
Below you will find*Medicare billing and coverage information fortobacco use screening for all adults and cessation interventions for tobacco users.
*Note: When a medically necessary Evaluation and Management (E/M) service is provided on the same day as the smoking and tobacco-use cessation counseling service, physicians and qualified non-physician practitioners shall use HCPCS 99201 – 99215 to report an E/M service with modifier 25 to indicate that the E/M service is a separately identifiable service from a smoking and tobacco-use cessation counseling service.
Counseling to Prevent Tobacco Useper NCD 210.4.1 and CR-8197 found on the CMS.gov website.
MCS and MACs shall pay for counseling to prevent tobacco use services for hospitalized and outpatient Medicare patients containing HCPCS G0436 or G0437 for a combined total of 8 sessions within a *12-month period with approved diagnosis as follows:
1. Who use tobacco, regardless of whether they have signs or symptoms of tobacco-related disease;
2. Who are competent and alert at the time that counseling is provided; and,
3. Whose counseling is furnished by a qualified physician or other Medicare-recognized practitioner.
G0436: Long Descriptor: Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes, Short Descriptor: Tobacco-use counsel 3-10 min;
G0437: Long Descriptor: Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes, Short Descriptor: Tobacco-use counsel >10 min.
*NOTE: In calculating a 12-month period, 11 months must pass following the month in which the 1st Medicare covered cessation counseling session was performed.
ICD-9-CM ICD-9 DX Description ICD-10 CM ICD-10 DX Description
305.1 Tobacco use disorder F17.200 Nicotine dependence, unspecified, uncomplicated
305.1 Tobacco use disorder F17.201 Nicotine dependence, unspecified, in remission
305.1 Tobacco use disorder F17.210 Nicotine dependence, cigarettes, uncomplicated
305.1 Tobacco use disorder F17.211 Nicotine dependence, cigarettes, in remission
305.1 Tobacco use disorder F17.220 Nicotine dependence, chewing tobacco, uncomplicated
305.1 Tobacco use disorder F17.221 Nicotine dependence, chewing tobacco, in remission
305.1 Tobacco use disorder F17.290 Nicotine dependence, other tobacco product, uncomplicated
305.1 Tobacco use disorder F17.291 Nicotine dependence, other tobacco product, in remission
V15.82 Pers. H/O tobacco use Z87.891 Personal history of nicotine dependence
Smoking and Tobacco-Use Cessation Counseling per NCD 210.4 and CR-8197 found on the CMS.gov website.
MCS and MACs shall allow CPTs 99406 and 99407 with approved diagnosis for a patient with a disease or an adverse health effect that has been found by the U.S. Surgeon General to be linked to tobacco use, or who is taking a therapeutic agent whose metabolism or dosing is affected by tobacco use as based on FDA-approved information. Payment for cessation counseling is limited to two cessation attempts per year; each attempt includes a maximum of four intermediate or intensive sessions, up to eight sessions in a*12-month period.
99406- Smoking and tobacco-use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes; and
99407- Smoking and tobacco-use cessation counseling visit; intensive, greater than 10 minutes
*NOTE: In calculating a 12-month period, 11 months must pass following the month in which the 1st Medicare covered cessation counseling session was performed.
When submitting a claim for cessation counseling, you are required to include the additional diagnosis for a disease or an adverse health effect linked to tobacco use, or for a patient who is taking a therapeutic agent whose metabolism or dosing is affected by tobacco use. The following ICD-10 codes for Nicotine use will be mandatory October 1, 2014.
ICD-10 CM ICD-10 DX Description
F17.200 Nicotine dependence, unspecified, uncomplicated
F17.201 Nicotine dependence, unspecified, in remission
F17.210 Nicotine dependence, cigarettes, uncomplicated
F17.211 Nicotine dependence, cigarettes, in remission
F17.220 Nicotine dependence, chewing tobacco, uncomplicated
F17.221 Nicotine dependence, chewing tobacco, in remission
F17.290 Nicotine dependence, other tobacco product, uncomplicated
F17.291 Nicotine dependence, other tobacco product, in remission
T65.211A Toxic effect of chewing tobacco, accidental (unintentional), initial encounter
T65.212A Toxic effect of chewing tobacco, intentional self-harm, initial encounter
T65.213A Toxic effect of chewing tobacco, assault, initial encounter
T65.214A Toxic effect of chewing tobacco, undetermined, initial encounter
T65.221A Toxic effect of tobacco cigarettes, accidental (unintentional), initial encounter
T65.222A Toxic effect of tobacco cigarettes, intentional self-harm, initial encounter
T65.223A Toxic effect of tobacco cigarettes, assault, initial encounter
T65.224A Toxic effect of tobacco cigarettes, undetermined, initial encounter
T65.291A Toxic effect of other tobacco and nicotine, accidental (unintentional), initial encounter
T65.292A Toxic effect of other tobacco and nicotine, intentional self-harm, initial encounter
T65.293A Toxic effect of other tobacco and nicotine, assault, initial encounter
T65.294A Toxic effect of other tobacco and nicotine, undetermined, initial encounter
Z87.891 Personal history of nicotine dependence
The time is now to talk to your patients about tobacco use!
