Basics of CPT code 99406 & 99407
Individual behavior change intervention services are counseling and/or intervention services directed at high-risk behaviors such as tobacco, alcohol, and substance abuse. These services can be reported as treatment of the condition or in relation to the condition that has the potential of causing illness or injury. Additionally, the encounter uses validated instruments to determine the patient’s opinion related to behavior change and providing input on a plan to change behavior with appropriate actions and motivation. CPT code 99406 is used to report for smoking and tobacco cessation counseling requiring three to 10 minutes of time and CPT code 99407 for counseling requiring more than ten minutes.
Read also: Alcohol use, Abuse and nicotine dependence ICD 10 coding guide
Description of CPT code 99406 & 99407
99406 Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes
99407 intensive, greater than 10 minutes
CPT code 99407 is not an add-on code, and the two codes are never reported together. Report only one of the codes, depending on the time of the counseling.
Use CPT code 99408 for alcohol and/or substance abuse screening utilizing such instruments as AUDIT, DAST, and intervention services requiring 15 to 30 minutes; for more than 30 minutes, report 99409.
99408 Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services; 15 to 30 minutes
99409 greater than 30 minutes
For a Medicare patient to qualify for smoking cessation counseling they must meet the following requirements:
- Use tobacco, regardless of whether they exhibit signs or symptoms of tobacco-related disease
- Patient must be competent and alert at the time of counseling.
- Counseling must be provided by a qualified physician or other Medicare-recognized healthcare provider.
Read also: Coding guide for secondary Z codes in ICD 10
Frequency
Two cessation attempts per year. Each attempt may include a maximum of 4 intermediate or intensive sessions, with the total annual benefit covering up to 8 sessions per year.
Do not report services of less than 15 minutes with CPT code 99408
Use CPT code 99408 & 99409 only for initial screening and breif intervention.
A unit of time is attained when the mid-point is passed. For example, an hour is attained when 31 minutes have elapsed (more than midway between zero and sixty minutes). A second hour is attained when a total of 91 minutes have elapsed. When codes are ranked in sequential typical times and the actual time is between two typical times, the code with the typical time closest to the actual time is used
Time spent providing smoking and tobacco use cessation counseling (99406-99407) or alcohol and/or substance abuse structured screening and brief intervention services (99408-99409) are not included in the time applied to psychiatric collaborative care management services (99492-99494) and should be separately reported using the appropriate code.
Read also: When to use Thyroid imaging/uptake CPT code 78012 & 78013
General information about CPT code 99406
Global
Work RVU/Base Units: 0.24
Non Facility Practice Expense RVU: 0.18
Facility Practice Expense RVU: 0.09
Professional Liability Insurance RVU: 0.02
Non Facility Total RVU: 0.44
Facility Total RVU: 0.35
Medicare Non Facility National Payment: $14.91
Medicare Facility National Payment: $11.86
Medicare Status*: A
Medicare Policy Indicators*: A+
General information about CPT code 99407
Supporting ICD 10 codes for CPT code 99406 & 99407
Tobacco Use Screening
The ICD 10 CM diagnosis code that may be reported for tobacco screening is Z13.89
Z13.89 Encounter for screening for other disorder
Tobacco use
Tobacco use may be reported when the heath care provider has not documented nicotine dependence.
Z72.0 Tobacco use
Z87.891 Personal history of nicotine dependence
Z71.6 Tobacco abuse counseling
A code for code section F17 can be reported for nicotine dependence.
F17.20 Nicotine dependence, unspecified
F17.200 Nicotine dependence, unspecified, uncomplicated
F17.201 Nicotine dependence, unspecified, in remission
F17.203 Nicotine dependence unspecified, with withdrawal
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
F17.22 Nicotine dependence, chewing tobacco
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
F17.29 Nicotine dependence, other tobacco product
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
Toxic effects of tobacco and nicotine can also be reported with CPT code 99406 & 99407 from T65.2 series.
T65.2 Toxic effect of tobacco and nicotine
T65.211 Toxic effect of chewing tobacco, accidental (unintentional)
T65.212 Toxic effect of chewing tobacco, intentional self-harm
T65.213 Toxic effect of chewing tobacco, assault
T65.214 Toxic effect of chewing tobacco, undetermined
T65.22 Toxic effect of tobacco cigarettes
Toxic effect of tobacco smoke
T65.221 Toxic effect of tobacco cigarettes, accidental (unintentional)
T65.222 Toxic effect of tobacco cigarettes, intentional self-harm
T65.223 Toxic effect of tobacco cigarettes, assault
T65.224 Toxic effect of tobacco cigarettes, undetermined
T65.29 Toxic effect of other tobacco and nicotine
T65.291 Toxic effect of other tobacco and nicotine, accidental (unintentional)
T65.292Toxic effect of other tobacco and nicotine, intentional self-harm
T65.293 Toxic effect of other tobacco and nicotine, assault
T65.294 Toxic effect of other tobacco and nicotine, undetermined
