Medicare makes more behavioral intervention changes for 2008
From the February ACP Internist, copyright © 2008 by the American College of Physicians.
By Brian Whitman
This month’s column looks at four new codes for behavior change interventions that were part of changes made to Current Procedural Terminology (CPT) and Medicare billing for 2008.
Q: What should I know about behavior change interventions in 2008?
A: There are four new codes that internists may use: two for tobacco use cessation counseling and two for alcohol and/or substance abuse screening and brief intervention.
Q: How do I report the tobacco use cessation counseling codes?
A: In March 2005, the CMS created two tobacco use cessation codes that were reported using two agency-created G codes, G0375 and G0376. These codes could only be used for Medicare patients. Now, those services should be reported for patients using the following newly created CPT codes:
- 99406 (formerly G0375): Smoking and tobacco use cessation counseling visit; intermediate, greater than three minutes, up to 10 minutes
- 99407 (formerly G0376): Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes
These codes have identical descriptions to those for the G codes, which Medicare will no longer accept. Private payers may also begin to pay for these services now that CPT codes have been made available.
Q: Does the new coding affect coverage for tobacco use cessation counseling?
A: No. CMS has not announced that it will make any changes to the coverage for this counseling service. Medicare will continue to cover two cessation attempts per 12-month period for each eligible beneficiary. Each attempt may include up to four face-to-face counseling sessions. The national Medicare payment rate for the new codes is:
- 99406 $12.24
- 99407 $24.01
These payments reflect the 0.5% increase in Medicare fees paid to physicians that is scheduled to be implemented for the first six months of 2008. If Congress does not act to avert a planned cut in July of 2008, these payments will be reduced by at least 10.1% like that for all other services.
Q: How do I code for alcohol abuse screening and brief intervention?
A: CPT created two new codes for reporting these services in 2008:
99408: Alcohol and/or substance (other than tobacco) abuse structured screening (e.g. AUDIT, DAST) and brief intervention (SBI) services; 15 to 30 minutes
99409: Alcohol and/or substance (other than tobacco) abuse structured screening (e.g. AUDIT, DAST) and brief intervention (SBI) services; greater than 30 minutes
These codes are less likely to be used on a regular basis by internists than the tobacco cessation counseling codes due to the length of time required and the requirement to use a structured tool.
Q: Will Medicare pay for these codes?
A: No. Medicare has announced that it will not pay for these codes because the description of the code includes a screening service, which Medicare does not cover. Medicare did create two new G codes that are nearly identical to the CPT codes, but change the word screening to assessment. For a 15- to 30-minute service to a Medicare patient, you should use code G0396 and you will be paid $29.42 on the national fee schedule. For a 30-minute or more service to a Medicare patient, use code G0397 and you will be paid $57.69 on the national fee schedule. These payments reflect the 0.5% increase in Medicare fees paid to physicians that is scheduled to be implemented for the first six months of 2008. If Congress does not act to avert a planned cut in July, these payments will be reduced by at least 10.1% like that for all other services.
Private insurers may pay for the CPT codes for this service, but are unlikely to use the G codes.
Q: What has changed with nursing facility services in 2008?
A: With the publication of CPT 2008, typical times have been added to the initial and subsequent nursing facility services E/M codes. The typical times indicate how long a typical service might take for a physician. For example, code 99307, the lowest level subsequent nursing facility service, is listed as having a typical time of 10 minutes.
Typical time comes into play in two situations. First, if a physician wants to bill based on time, as opposed to the usual level-of-service selection by extent of history, exam and medical decision making, he must spend at least half of the typical time for a code on counseling or coordination of care and document that he did so. The addition of these times allows for that time-based billing in the nursing facility. Secondly, a physician may report prolonged services codes (99354-99359) if the time he or she spends performing the work significantly exceeds the typical times listed in the CPT book. The addition of typical times for the nursing facility services allows physicians to use prolonged services codes in the nursing facility setting as appropriate.
Brian Whitman is Senior Analyst for Regulatory and Insurer Affairs in ACP’s Washington, D.C. office.
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