Hospitalist Based Smoking Cessation Counseling Does Work And Is Paid For With CPT® medical coding Codes 99406 and 99407
She was a 59 year old schizophrenic well known to Happy's service. She'd been in and out of the hospital at least 6 times a year for the preceding five years, always for conditions related to smoking. At 59 years old, she finds herself in chronic hypercapnic and hypoxemic respiratory failure, requiring on average, 4 liters of oxygen support at all times.
I have personally admitted her four times. And each time I would discuss her smoking status and encourage her to quit. Each time she would discuss her desire to quit but always failing to follow through. She would be discharged, usually with the expectation that she would return in a month or two with the progressive revolving door of smoking related respiratory and cardiac failure.
I would place her government funded smoking related medical expenses at well over 1 million dollars between her inpatient admissions, her outpatient follow ups and her chronic medication, oxygen and mobility devices. One million dollars that could have compounded for generations to support the elderly in their final months of healthy living. One million dollars that could have funded ten times as many people in the final stages of their advanced end of life aging process.
People who smoke die young. But they still become net consumers as opposed to producers. If they don't quit smoking for good, they become disabled and live that way for years upon years upon years before succombing to their premature death.. They spend vast amounts of economic resources that could have compounded for generations before their body was meant to fail.
Every time I see a smoker I discuss their desire to quit smoking. If they show a desire, I give them my smoking lecture. I recently learned that smoking cessation counseling is paid for by Medicare under CPT® code 99406 (3-10 minutes of counseling) and 99407 (greater than 10 minutes) if the patient's condition is related to their smoking. Medicare will pay it up to eight times a year and it can be billed by any doctor. They are add on codes to other E&M services. You just need to document that their medical condition is related to tobacco abuse and that you counseled them on quitting, options, patient expectations, plans etc...
The last time I saw her was an evaluation for admission in the emergency room for dyspnea. Her baseline carbon dioxide was normal, for her. Her chronic oxygen needs were normal, for her. Her complaints were undifferentiated from her chronic complaints.
Except this time she wasn't a smoker. And she told me I was her inspiration. She told me my lectures to her inspired her desire to give it up. For over four decades she slaved away at the grips of a nicotine addiction.
Whenever you feel like your words are just that, it's nice to know that some folks out there are actually listening. I may have added a good three or four years to her life to spend with her children and grandchildren. I may have prevented her from getting admitted to the hospital six times a year. Perhaps now it will be only two or three.
Perhaps someday, instead of getting paid $12 or $25 for my tobacco counseling under fee for service, I will get a gainsharing reward for keeping her out of the hospital.
I sent her home that day. Home because she wasn't having a COPD exacerbation. Home because she was stable, for her. Home to be with her family and away from the expensive and dangerous hospital environement.
Who says hospitalists can't make a difference when it comes to quitting smoking. Just remember to get paid for the effort you make. Bill out an add on CPT® code 99406 or 99407 based on the time you spent. And don't forget, if your patient is poor, they can get free Chantix. UPDATE: Chantix lawsuits, here we come.
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