Smoking Cessation

October 1, 2007

As an otolaryngologist where tobacco use is a main risk factor in head and neck surgery, when is appropriate to use G0175 for tobacco cessation counseling, and how should it be used in relation to E&M codes and additional CPT codes? What documentation is necessary?

Question: As an otolaryngologist where tobacco use is a main risk factor in head and neck surgery, when is appropriate to use G0175 for tobacco cessation counseling, and how should it be used in relation to E&M codes and additional CPT codes? What documentation is necessary?

Answer: This response was provided by Sheri Poe Bernard of the AAPC:

Under the circumstance you describe, it would be inappropriate to report G0175 for tobacco cessation counseling. HCPCS Level II code G0175 reports “Scheduled interdisciplinary team conference (minimum of three exclusive of patient care nursing staff) with patient present.”

The code is intended for counseling that occurs when other non-physician clinicians are present, for example, a physical therapist, psychologist, or occupational therapist. Tobacco cessation counseling is considered part of the E&M service, and is not separately payable.

However, there are separate codes to report tobacco cessation counseling exclusive to patients with coronary artery disease, diabetes, or chronic obstructive pulmonary disease. These codes are part of CMS’ Physician Quality Reporting Initiative (PQRI) and may result in additional payment to the physician participating in the PQRI program. For patients with qualifying disorders, report cessation counseling with CPT Category II code 4000F: Tobacco Use Cessation Intervention, Counseling. If the counseling includes pharmacologic therapy as an intervention, report 4001F. These codes are used in combination with 1034F Current Tobacco Smoker, or 1035F Smokeless Tobacco User.

Documentation should relay information regarding the patient’s smoking habit and a description of the smoking intervention employed with the patient.