CODING & DOCUMENTATION

The primary difference between the codes is whether the patient has signs or symptoms of tobacco-related disease. If the patient does not, then you should use G0436 to bill a “Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes” or G0437 when intensive counseling exceeds 10 minutes. For symptomatic individuals, you should use codes 99406, “Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes” or 99407 when intensive counseling exceeds 10 minutes.

Payment for subsequent observation care is for all care rendered by the admitting physician on the day(s) other than the initial or discharge date. Other physicians who furnish consultations, evaluations, or services while the patient is receiving hospital outpatient observation services should bill outpatient service codes. However, if physicians in the same group practice and of the same specialty (e.g., two family physicians) see the patient at separate visits on the same day, they must submit a single code representative of the level of service of the combined visits. This is Medicare's policy; private payers' policies may vary.

Check with your Medicare Administrative Contractor (MAC) to see what options are available in your region to verify eligibility for the AWV and other preventive services. Some MACs provide eligibility information through Internet portals, but they may offer other ways to access the information as well.

Yes, you can if you are billing Medicare, which follows the CPT definition of a new patient: “one who has not received any professional services from the physician or another physician of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years.” Private payers vary on this rule, but if a payer rejects your claim, an appeal based on CPT instructions would be appropriate.