Patients who smoke cigarettes are at higher risk for death from lung cancer and COPD, and are more likely to develop coronary heart disease and stroke. Smoking increases the risk of developing type 2 diabetes and makes it more difficult to control, increases risk of cataracts, osteoporosis, severe obstetric and neonatal complications, reduced fertility and miscarriages, serious oral health problems, decreased immune function and increased inflammation, and rheumatoid arthritis.
In the past 20 years, more and more studies have demonstrated the negative impact of smoking on bone healing after a fracture, in terms of delayed union, nonunion, and other serious complications.
The negative effects of cigarettes on patients’ health and outcomes cut across all specialties. Counseling patients to stop smoking is an essential step in providing care, whether in an internal medicine clinic, or a surgical specialty. This Coding Alert will explain how to document this counseling in the patient record for reimbursement and to support the medical necessity of interventions such as smoking cessation medications.
How to Document
While the EHR usually has a template for tracking tobacco counseling, providers may find it easier to document the time and content of the counseling directly in the SOAP note. This can be done in the A&P section. Here are the elements to capture, in one brief paragraph:
Example: A 67-year-old male patient presents with exacerbated COPD on oxygen. This patient continues to smoke one pack of cigarettes per day after several failed attempts at quitting. Approximately 15 minutes were spent counseling the patient in cessation techniques. He understands continuing to smoke could lead to stroke and death. The benefits of stopping were also presented to him. The patient has verbalized his desire to “give it another try.” He has set his own goal of 30 days to be completely smoke-free. We will follow up in two weeks to check progress.
How to Code
The CPT codes for tobacco cessation counseling are:
99406 Tobacco use cessation intermediate 3-10 minutes
99407 greater than 10 minutes
Diagnosis codes should be carefully chosen to reflect the severity of the patient’s tobacco use, as well as the pertinent comorbidity. Disorders from chapter 5, Mental, Behavioral and Neurodevelopmental Disorders (F01-F99), should be coded, according to the provider’s judgment, as long as the tobacco use “is associated with a mental or behavioral disorder [dependence], and such a relationship is documented by the provider.” Add at least one code for the comorbid condition, such as COPD.
Applicable primary diagnoses:
F17.200-F17.209 Nicotine dependence, unspecified
F17.210 -F17.219 Nicotine dependence, cigarettes
F17.220-F17.229 Nicotine dependence, chewing tobacco
F17.290 -F17.299 Nicotine dependence, other tobacco product
For uncomplicated cigarette dependence/addiction, use F17.210. Code Z72.0 Tobacco use, may be reported when the provider has not documented nicotine dependence.
 CDC “Health effects of cigarette smoking”, https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/index.htm
 R.A. Patel et al “The effect of smoking on bone healing: A systematic review” in Bone & Joint Research 2013 Jun; 2(6): 102-111, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3686151/
 Kasandra Bolzenius, CPC “Get paid for smoking cessation”, AAPC Knowledge Center, first published in Healthcare Business Monthly, July 2016, https://www.aapc.com/blog/35703-get-paid-for-smoking-cessation/.
 Note that Medicare codes G0436-G0437 were deleted in 2016, and replaced with the CPT codes.
 ICD-10-CM 2018, Guidelines, https://www.cdc.gov/nchs/data/icd/10cmguidelines_fy2018_final.pdf
Kimberly A. Sherman, MA, CPC - Reimbursement warrior and HIPAA guru.