Smoking Cessation Counselling

Smoking Cessation

The following codes are used to report the preventive medicine evaluation and management of infants, children, adolescents, and adults.

Modifier 25 should be added to the office/outpatient code to indicate that a significant, separately identifiable evaluation and management service was provided on the same day as the preventive medicine service. The appropriate preventive medicine service is additionally reported.

• 99406 – Smoking and tobacco-use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes 
• 99407 – Smoking and tobacco-use cessation counseling visit; intensive, greater than 10 minutes 

Required Documentation

• Patient Current smoking details 
• Time 
• Counseling Content 

Covered ICD Codes 

• F17.210 - Nicotine dependence, cigarettes, uncomplicated

• F17.211 - Nicotine dependence, cigarettes, in remission

• F17.213 - Nicotine dependence, cigarettes, with withdrawal

• F17.218 - Nicotine dependence, cigarettes, with other nicotine-induced disorders

• F17.219 - Nicotine dependence, cigarettes, with unspecified nicotine-induced disorders

• F17.220 - Nicotine dependence, chewing tobacco, uncomplicated

• F17.221 - Nicotine dependence, chewing tobacco, in remission

• F17.223 - Nicotine dependence, chewing tobacco, with withdrawal

• F17.228 - Nicotine dependence, chewing tobacco, with other nicotine-induced disorders

• F17.229 - Nicotine dependence, chewing tobacco, with unspecified nicotine-induced disorders

• F17.290 - Nicotine dependence, other tobacco product, uncomplicated

• F17.291 - Nicotine dependence, other tobacco product, in remission

• F17.293 - Nicotine dependence, other tobacco product, with withdrawal

• F17.298 - Nicotine dependence, other tobacco product, with other nicotine-induced disorders

• F17.299 - Nicotine dependence, other tobacco product, with unspecified nicotine-induced disorders

Clinical Example

The patient confirms the use of tobacco products (specify the product). Smoking 4 cigarettes per day.  

Spent 10 minutes for counseling and patient education about the dangers of smoking, health risk, and education hand out given to the patients for awareness. 

Discussed in detail complications with treatment plan due to continued use of tobacco products. The patient listen carefully and accepted to stop smoking  

COVID-19 updates UnitedHealthcare

Temporary cost-share waivers extended to Oct. 17, 2021

The national public health emergency has been extended from July 19, 2021, to Oct. 17, 2021. Below is an overview of how that extension affects temporary provisions for COVID-19 testing and testing-related visits.

Individual Exchange, Individual and Group Market health plans: 

• From Feb. 4, 2020, through the national public health emergency period, United Healthcare is waiving cost-sharing for in-network and out-of-network COVID-19 tests and testing-related visits.

Medicare Advantage: 

• From Feb. 4, 2020, through the national public health emergency period, United Healthcare is waiving cost-sharing for in-network and out-of-network tests for COVID-19, including testing-related telehealth visits.

Medicaid: 

• State-specific rules and other state regulations may apply. For Medicaid and other state-specific regulations, please refer to your state-specific website or your state’s United Healthcare Community Plan website. 

CMS Unveils Surprise-Billing Rules

Proposed Billing Rules 2022

CMS unveiled July 2 the first in a series of rules aimed at shielding patients from surprise billing. The interim final rule addresses several provisions in the No Surprises Act passed by Congress last year.

Most provisions outlined in the proposed rule will not take effect until Jan. 1, 2022. 

Ten things to know,

1. Bans surprise billing for emergency services

• The interim final rule bans surprise billing for emergency services, regardless of where they are provided. 
• Providers are required to bill emergency services on an in-network basis without prior authorization.

2. Bans high out-of-network cost-sharing for emergency and non-emergency services 

• CMS proposed that patient cost-sharing, including coinsurance and deductibles, be based on in-network provider rates. 
• This means that cost-sharing can't be higher than if the services were provided by an in-network physician. 

3. Bans surprise billing for ancillary services and any "others." 

• The interim final rule prohibits out-of-network charges for ancillary care in in-network facilities in all instances. This includes anesthesiology services. 
• CMS said that it also includes a ban on any other out-of-network charges to patients without notice. 

4. Interim payment or notice of denial from insurers. 

• The interim final rule would require health plans to make an initial payment or issue a notice of denial to providers in 30 days after it receives a clean claim. 

5. Consent process to waive balance-billing protections. 

• The law allows patients to waive their balance-billing protections and consent to out-of-network charges. 
• The rule directs the departments to establish a process to obtain patient consent for balance billing. Providers can't use this for emergency services or some ancillary services.

6. Providers must disclose balance-billing protections. 

• Providers will be required to post publicly to inform patients about their surprise-billing protections.

7. Qualifying payment amount. 

• CMS defined the qualifying payment amount, which will calculate patient cost-sharing and be used by an arbiter in the independent dispute resolution process, as the issuer's median in-network rate for 2019 trended forward. 
• The rule addresses several factors that will determine how the rates are set, including the type of contract, insurance market, geographic region, and rates for the same or similar services. 

8. Complaint process. 

• Through the proposed rule, CMS will establish a process for which patients and others can submit complaints about violations of the balance-billing requirements. 

9. Arbitration process. 

• The first interim rule doesn't discuss the dispute resolution process. 

10. Comment period. 

• Providers will have 60 days to comment on the interim final rule.

ICD-10 CM Clinical Examples for Documentation

CLINICAL DOCUMENTATION

The providers need to be specifying the anatomical location and laterality in the documentation to select the appropriate most specific ICD codes. 

There are a few examples of clinical documentation updated below and how the physicians and clinicians communicate and what they pay attention to it is a matter of ensuring the information is captured in your documentation.

In ICD-10-CM, there are three main categories of changes,

• Definition Changes
• Terminology Differences
• Increased Specificity

The expansion of ICD-10 codes is due to the addition of laterality (left, right, bilateral). Physicians and other clinicians likely already note the side when evaluating the clinically pertinent anatomical site(s).

Clinical Examples:1 - ACUTE MYOCARDIAL INFARCTION (AMI)

When documenting an AMI, include the following,

Time-frame an AMI is now considered “acute” for 4 weeks from the time of the incident.

The episode of care ICD-10 does not capture an episode of care (e.g. initial, subsequent, sequelae).

Subsequent AMI ICD-10 allows coding of a new MI that occurs during the 4 weeks “acute period” of the original AMI.

• I21.02 ST elevation (STEMI) myocardial infarction involving left anterior descending coronary artery
• I21.4 Non-ST elevation (NSTEMI) myocardial infarction
• I22.1 Subsequent ST elevation (STEMI) myocardial infarction

Clinical Examples:2 - HYPERTENSION

In ICD-10, hypertension is defined as essential (primary). The concept of “benign or malignant” as it relates to hypertension no longer exists.

When documenting hypertension, include the following,

Types Hypertension - HTN, e.g. essential, secondary, etc.

Causal relationship e.g. Renal, pulmonary, etc.

• I10 Essential (primary) hypertension
• I11.9 Hypertensive heart disease without heart failure
• I15.0 Reno-vascular hypertension

Clinical Examples:3 - ASTHMA

ICD-10 terminology used to describe asthma has been updated to reflect the current clinical classification system.

When documenting asthma, include the following,

Cause Exercise-induced, cough variant, related to smoking, chemical or particulate cause, occupational.

Severity Choose one of the three options below for persistent asthma patients

• Mild persistent
• Moderate persistent
• Severe persistent

Temporal Factors Acute, chronic, intermittent, persistent, status asthmatics,  acute exacerbation,

• J45.30 Mild persistent asthma, uncomplicated
• J45.991 Cough variant asthma

Clinical Examples:4 - UNDER-DOSING

Underdosing is an important new concept and term in ICD-10. It allows you to identify when a patient is taking less of a medication than is prescribed.

When documenting underdosing, include the following,

Intentional, Unintentional, Non-compliance Is the underdosing deliberate? (e.g., patient refusal).

Reason Why is the patient not taking the medication? (e.g.financial hardship, age-related debility).

• Z91.120 Patient’s intentional underdosing of medication regimen due to  financial hardship
• T36.4x6A Underdosing of tetracyclines, initial encounter
• T45.526D Underdosing of antithrombotic drugs, subsequent encounter

Clinical Examples:5 - DIABETES MELLITUS, HYPOGLYCEMIA, AND HYPERGLYCEMIA

The diabetes mellitus codes are combination codes that include the type of diabetes mellitus, the body system affected, and the complications affecting that body system. When documenting diabetes, include the following,

Type e.g. Type 1 or Type 2 disease, drug or chemical induces, due to underlying condition, gestational.

Complications What (if any) other body systems are affected by the diabetes condition? e.g. Foot ulcer related to diabetes mellitus.

Treatment Is the patient on insulin?.

A second important change is the concept of “hypoglycemia” and “hyperglycemia.” It is now possible to document and code for these conditions without using “diabetes mellitus.”  The provider can also specify if the condition is due to a procedure or other cause.

The final important change is that the concept of “secondary diabetes Mellitus” is no longer used; instead, there are specific secondary options.

• E08.65 Diabetes Mellitus due to underlying condition with hyperglycemia
• E09.01 Drug or chemical induced diabetes Mellitus with  hyperosmolarity with coma
• R73.9 Transient post-procedural hyperglycemia
• R79.9 Hyperglycemia, unspecified

Clinical Examples:6  ABDOMINAL PAIN AND TENDERNESS

When documenting abdominal pain, including the following,

Location e.g. Generalized, Right upper quadrant, periumbilical, etc.

Pain or tenderness type e.g. Colic, tenderness, rebound

• R10.31 Right lower quadrant pain
• R10.32 Left lower quadrant pain
• R10.33 Periumbilical pain

Cardiac Device Billing CPT Codes

Cardiac Device Monitoring Services

CPT 93294, 93295, 93296 -  Reported no more than once every 90 days. Do not report if the monitoring period is less than 30 days.

CPT 93297, 93299, G2066 -  Reported no more than once every 30 days. Do not report if the monitoring period is less than 10 days.

CPT 93264 - Reported no more than once every 30 days. Do not report if the monitoring period is less than 30 days.

May not be reported with in-person interrogation device evaluations and programming on the same date by the same individual.

For subcutaneous cardiac rhythm monitors, may not be reported with programming device evaluations for pacemakers and ICDs.

It may be reported with programming device evaluations during the remote interrogation device evaluation period.

May not be reported with in-person interrogation and device evaluations on the same date by the same individual. 

Report only remote services when an in-person interrogation device evaluation is performed during a period of remote interrogation device evaluation. 

However, a service center may report the technical code for remote interrogation (93296) during a period in which a physician or other qualified health professional performs an in-person interrogation device evaluation.

Peri-Procedural Device Evaluation Reported once before and once after surgery, procedure or test, when device evaluation and programming is performed before and after surgery, procedure or test.

If one provider performs both the pre-and post-evaluation and programming service, the appropriate code (93286 for pacemakers or 93287 for implantable defibrillators) would be reported two times. 

If one provider performs the pre-surgical service and a separate provider performs the post-surgical service, each provider reports either code only one time.

Programming or Device ERI/EOL

Z45.01 Encounter for adjustment and management of cardiac pacemaker or cardiac resynchronization therapy pacemaker (CRT-P)

Z45.02 Encounter for adjustment and management of automatic implantable cardiac defibrillator, automatic implantable cardiac defibrillator with synchronous cardiac pacemaker or cardiac resynchronization therapy defibrillator (CRT-D)

Z45.09 Encounter for adjustment and management of other cardiac device [used for ICMs] 

Interrogations

Z95.0 Presence of cardiac pacemaker or cardiac resynchronization therapy (CRT-P) pacemaker

Z95.810 Presence of automatic (implantable) cardiac defibrillator, automatic (implantable) cardiac defibrillator with synchronous cardiac pacemaker, cardiac resynchronization therapy defibrillator (CRT-D) or cardioverter-defibrillator (ICD)

Z95.818 Presence of other cardiac implants and grafts [for ICMs]

Note

Physicians should not report codes 93264 and G2066 together because 93264 includes the professional and technical components in the payment rate. 

However, G2066 may be billable by Outpatient Hospitals for the technical data acquisitions of PA pressure sensor remote monitoring if the requirements of the code are met.  

Check RPM Guidelines

Glimpses of ICD 10 CM Revised Codes - 2022

Changes Codes Description

Revise from: G7120 Congenital myopathy, unspecified

Revise to: G7120 Congenital myopathy, unspecified

Revise from: M3500 Sicca syndrome, unspecified

Revise to: M3500 Sjogren syndrome, unspecified

Revise from: M3501 Sicca  syndrome with keratoconjunctivitis

Revise to: M3501 Sjogren syndrome with keratoconjunctivitis

Revise from: M3502 Sicca  syndrome with lung involvement

Revise to: M3502 Sjogren syndrome with lung involvement

Revise from: M3503 Sicca syndrome with myopathy

Revise to: M3503 Sjogren syndrome with myopathy

Revise from: M3504 Sicca syndrome with tubulo-interstitial nephropathy

Revise to: M3504 Sjogren syndrome with tubulo-interstitial nephropathy

Revise from: M3509 Sicca  syndrome with other organ involvement

Revise to: M3509 Sjogren syndrome with other organ involvement

Revise from: T63611A Toxic effect of contact with Portugese Man-o-war, accidental (unintentional), initial encounter

Revise to: T63611A Toxic effect of contact with Portuguese Man-o-war, accidental (unintentional), initial encounter

Revise from: T63611D Toxic effect of contact with Portugese Man-o-war, accidental (unintentional), subsequent encounter

Revise to: T63611D Toxic effect of contact with Portuguese Man-o-war, accidental (unintentional), subsequent encounter

Revise from: T63611S Toxic effect of contact with Portugese Man-o-war, accidental (unintentional), sequela

Revise to: T63611S Toxic effect of contact with Portuguese Man-o-war, accidental (unintentional), sequela

Revise from: T63612A Toxic effect of contact with Portugese Man-o-war, intentional self-harm, initial encounter

Revise to: T63612A Toxic effect of contact with Portuguese Man-o-war, intentional self-harm, initial encounter

Revise from: T63612D Toxic effect of contact with Portugese Man-o-war, intentional self-harm, subsequent encounter

Revise to: T63612D Toxic effect of contact with Portuguese Man-o-war, intentional self-harm, subsequent encounter

Revise from: T63612S Toxic effect of contact with Portugese Man-o-war, intentional self-harm, sequela

Revise to: T63612S Toxic effect of contact with Portuguese Man-o-war, intentional self-harm, sequela

Revise from: T63613A Toxic effect of contact with Portugese Man-o-war, assault, initial encounter

Revise to: T63613A Toxic effect of contact with Portuguese Man-o-war, assault, initial encounter

Revise from: T63613D Toxic effect of contact with Portugese Man-o-war, assault, subsequent encounter

Revise to: T63613D Toxic effect of contact with Portuguese Man-o-war, assault, subsequent encounter

Revise from: T63613S Toxic effect of contact with Portugese Man-o-war, assault, sequela

Revise to: T63613S Toxic effect of contact with Portuguese Man-o-war, assault, sequela

Revise from: T63614A Toxic effect of contact with Portugese Man-o-war, undetermined, initial encounter

Revise to: T63614A Toxic effect of contact with Portuguese Man-o-war, undetermined, initial encounter

Revise from: T63614D Toxic effect of contact with Portugese Man-o-war, undetermined, subsequent encounter

Revise to: T63614D Toxic effect of contact with Portuguese Man-o-war, undetermined, subsequent encounter

Revise from: T63614S Toxic effect of contact with Portugese Man-o-war, undetermined, sequela

Revise to: T63614S Toxic effect of contact with Portuguese Man-o-war, undetermined, sequela

Revise from: Z9225 Personal history of immunosupression therapy

Revise to: Z9225 Personal history of immunosuppression therapy

Return to view New Codes

Check Deleted Codes

Glimpses of ICD 10 CM Deleted Codes - 2022

Deleted Codes Description

D552  Anemia due to disorders of glycolytic enzymes

F78  Other intellectual disabilities

G92 Toxic encephalopathy

K228 Other specified diseases of esophagus

M311 Thrombotic microangiopathy

M545 Low back pain

P09  Abnormal findings on neonatal screening

R05  Cough

R358  Other polyuria

R633  Feeding difficulties

T407X1A  Poisoning by cannabis (derivatives), accidental (unintentional), initial encounter

T407X1D  Poisoning by cannabis (derivatives), accidental (unintentional), subsequent encounter

T407X1S  Poisoning by cannabis (derivatives), accidental (unintentional), sequela

T407X2A  Poisoning by cannabis (derivatives), intentional self-harm, initial encounter

T407X2D  Poisoning by cannabis (derivatives), intentional self-harm, subsequent encounter

T407X2S  Poisoning by cannabis (derivatives), intentional self-harm, sequela

T407X3A  Poisoning by cannabis (derivatives), assault, initial encounter

T407X3D  Poisoning by cannabis (derivatives), assault, subsequent encounter

T407X3S  Poisoning by cannabis (derivatives), assault, sequela

T407X4A  Poisoning by cannabis (derivatives), undetermined, initial encounter

T407X4D  Poisoning by cannabis (derivatives), undetermined, subsequent encounter

T407X4S   Poisoning by cannabis (derivatives), undetermined, sequela

T407X5A  Adverse effect of cannabis (derivatives), initial encounter

T407X5D  Adverse effect of cannabis (derivatives), subsequent encounter

T407X5S  Adverse effect of cannabis (derivatives), sequela

T407X6A  Underdosing of cannabis (derivatives), initial encounter

T407X6D Underdosing of cannabis (derivatives), subsequent encounter

T407X6S  Underdosing of cannabis (derivatives), sequela

Z590  Homelessness

Z594  Lack of adequate food and safe drinking water

Z598  Other problems related to housing and economic circumstances

Z915  Personal history of self-harm

Click here to view ICD 10 CM Revised Codes - 2022