How To Use CPT Code 99406

CPT 99406 refers to intermediate smoking and tobacco use cessation counseling lasting between 3 to 10 minutes. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 99406.

1. What is CPT 99406?

CPT 99406 is a medical billing code used to report intermediate smoking and tobacco use cessation counseling services provided by healthcare professionals. This code is specifically used for counseling sessions that last between 3 to 10 minutes. The purpose of this counseling is to help patients quit tobacco use by identifying barriers to cessation, discussing coping strategies, and providing support and resources.

2. 99406 CPT code description

The official description of CPT code 99406 is: “Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes.”

3. Procedure

The 99406 CPT code procedure involves the following steps:

1. Assessing the patient’s tobacco use history and readiness to quit.
2. Identifying barriers to cessation and potential relapse triggers.
3. Discussing practical coping strategies and techniques to overcome barriers.
4. Providing information on pharmacologic interventions, if appropriate.
5. Referring the patient to support groups or additional resources, if needed.
6. Documenting the discussion and the duration of the counseling session.

4. Qualifying circumstances

Patients eligible to receive CPT code 99406 services include those who:

• Are current tobacco users or have recently quit.
• Express a desire to quit or have made previous attempts to quit.
• Are at risk for tobacco-related health complications.
• Have been advised by their healthcare provider to quit tobacco use.

5. When to use CPT code 99406

It is appropriate to bill the 99406 CPT code when:

• The healthcare provider has conducted a counseling session lasting between 3 to 10 minutes.
• The counseling session focuses on smoking and tobacco use cessation.
• The provider has documented the discussion and the duration of the session in the patient’s medical record.

6. Documentation requirements

To support a claim for CPT 99406, the following information should be documented in the patient’s medical record:

• Date and duration of the counseling session.
• Assessment of the patient’s tobacco use history and readiness to quit.
• Identification of barriers to cessation and potential relapse triggers.
• Discussion of coping strategies and techniques to overcome barriers.
• Information on pharmacologic interventions, if appropriate.
• Referrals to support groups or additional resources, if needed.

7. Billing guidelines

When billing for CPT code 99406, keep in mind the following guidelines and tips:

• Ensure that the counseling session duration is accurately documented and falls within the 3 to 10-minute range.
• Verify that the patient meets the qualifying circumstances for receiving smoking cessation counseling services.
• Document all relevant information in the patient’s medical record to support the claim.
• Be aware of any payer-specific requirements or limitations on the frequency of billing for smoking cessation counseling services.

8. Historical information

CPT 99406 was added to the Current Procedural Terminology system on January 1, 2008. There have been no updates to the code since its addition.

9. Similar codes to CPT 99406

Five similar codes to CPT 99406 and how they differ are:

• CPT 99407: This code is used for smoking and tobacco use cessation counseling sessions lasting more than 10 minutes.
• CPT 99401: This code is for preventive medicine counseling services lasting up to 15 minutes, not specific to smoking cessation.
• CPT 99402: This code is for preventive medicine counseling services lasting between 16 to 30 minutes, not specific to smoking cessation.
• CPT 99403: This code is for preventive medicine counseling services lasting between 31 to 45 minutes, not specific to smoking cessation.
• CPT 99404: This code is for preventive medicine counseling services lasting between 46 to 60 minutes, not specific to smoking cessation.

10. Examples

Here are 10 detailed examples of CPT code 99406 procedures:

1. A 45-year-old patient with a history of smoking for 20 years receives a 7-minute counseling session on quitting smoking and managing withdrawal symptoms.
2. A 30-year-old patient who recently quit smoking receives a 5-minute counseling session on coping strategies to prevent relapse.
3. A 55-year-old patient with hypertension and a history of smoking receives a 9-minute counseling session on the benefits of quitting smoking and available pharmacologic interventions.
4. A 40-year-old patient with a family history of lung cancer receives a 6-minute counseling session on quitting smoking and the importance of regular lung cancer screenings.
5. A 50-year-old patient with diabetes and a history of smoking receives an 8-minute counseling session on the impact of smoking on diabetes management and the benefits of quitting.
6. A 35-year-old patient who recently quit smoking receives a 4-minute counseling session on managing cravings and identifying potential relapse triggers.
7. A 60-year-old patient with chronic obstructive pulmonary disease (COPD) and a history of smoking receives a 10-minute counseling session on the benefits of quitting smoking and available support resources.
8. A 25-year-old patient who smokes and is pregnant receives a 7-minute counseling session on the risks of smoking during pregnancy and strategies for quitting.
9. A 65-year-old patient with a history of smoking and a recent heart attack receives a 9-minute counseling session on the benefits of quitting smoking for cardiovascular health.
10. A 70-year-old patient with a history of smoking and osteoporosis receives an 8-minute counseling session on the impact of smoking on bone health and the benefits of quitting.