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99406 with 99214

Bea Posted Sat 23rd of June, 2012 05:19:26 AM

What needs to be documented for a GI physician to bill '99406' in addition to '99214'? Is it appropriate to bill these two codes together when: Patient presents with dysphasia and is diabetic. Plan is to do barium swallow and EGD.
He documents in his impressions "Smoking and tobacco cessation counseling 3-10 minutes" This is the only reference to the additional service.

SuperCoder Answered Tue 26th of June, 2012 06:27:23 AM

Any little more detailed documentation, such as what type of discussion took place etc., would be more helpful to bill the 99406 code. But yes, when the problem-oriented E/M has distinct diagnostic condition and adequate documentation, plus you also have documentation for smoking cessation, you should be able to report a separately identifiable E/M alongside coding cessation codes 99406 and 99407. You should append modifier 25 to the E/M code.

Rationale: The Medicare Claims Processing Manual, Chapter 32, Section 12.1, says, "Contractors shall allow payment for a medically necessary E/M service on the same day as the smoking and tobacco-use cessation counseling service when it is clinically appropriate."(www.cms.hhs.gov/manuals/downloads/clm104c32.pdf).

The manual then goes on to say you should append modifier 25 to the E/M to show it's separate from G0375 and G0376 (Smoking and tobacco use cessation counseling visit ...), which were the previous codes for the service.Although this paragraph still references the old codes, the descriptors for the old and new codes are the same

Caution: Third party payers may vary on whether you may report smoking cessation in addition to E/M.

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