How To Use HCPCS Code G9016

HCPCS code G9016 describes smoking cessation counseling provided to individuals for a duration of 6-10 minutes. This code is used specifically for counseling sessions related to smoking cessation and is not intended to be used in conjunction with any other evaluation and management service. In this article, we will explore the details of HCPCS code G9016, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS G9016?

HCPCS code G9016 is a specific code used to identify smoking cessation counseling services provided to individuals. It is important to note that this code is only applicable for counseling sessions that last between 6-10 minutes and are solely focused on smoking cessation. It should not be used in conjunction with any other evaluation and management service.

2. Official Description

The official description of HCPCS code G9016 is “Smoking cessation counseling, individual, in the absence of or in addition to any other evaluation and management service, per session (6-10 minutes) [demo project code only].” The short description for this code is “Demo-smoking cessation coun.”

3. Procedure

1. The provider initiates the smoking cessation counseling session with the individual.
2. During the session, the provider discusses the harmful effects of smoking and the benefits of quitting.
3. The provider assesses the individual’s smoking habits and addiction level.
4. Based on the assessment, the provider develops a personalized smoking cessation plan for the individual.
5. The provider educates the individual on various smoking cessation techniques and strategies.
6. Throughout the session, the provider provides support and guidance to the individual to help them quit smoking.
7. The session concludes with the provider scheduling a follow-up appointment to monitor the individual’s progress.

4. When to use HCPCS code G9016

HCPCS code G9016 should be used when providing individual smoking cessation counseling sessions that last between 6-10 minutes. It is important to ensure that the counseling session is solely focused on smoking cessation and is not performed in conjunction with any other evaluation and management service.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9016, healthcare providers should ensure that the following documentation requirements are met:

• Documentation of the individual’s smoking history and addiction level.
• Evidence of the personalized smoking cessation plan developed for the individual.
• Documentation of the counseling session, including the topics discussed and any strategies provided.
• Documentation of any follow-up appointments scheduled to monitor the individual’s progress.

6. Historical Information and Code Maintenance

HCPCS code G9016 was added to the Healthcare Common Procedure Coding System on January 01, 2001. Since its addition, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

HCPCS code G9016 is classified as non-covered by Medicare, indicated by the coverage code M. This means that Medicare does not provide reimbursement for smoking cessation counseling sessions using this code. It is important to check with other insurance providers to determine their coverage policies for this specific code.

8. Examples

Here are five examples of scenarios where HCPCS code G9016 should be billed:

1. An individual visits their primary care physician for a routine check-up and expresses their desire to quit smoking. The physician provides a 10-minute counseling session focused on smoking cessation.
2. A pulmonologist sees a patient who has been diagnosed with a smoking-related respiratory condition. During the visit, the pulmonologist spends 8 minutes discussing the benefits of quitting smoking and provides strategies to help the patient quit.
3. A nurse practitioner conducts a smoking cessation counseling session with a pregnant patient during a prenatal visit. The session lasts for 7 minutes and focuses on the risks of smoking during pregnancy and the importance of quitting for the health of the baby.
4. A tobacco cessation specialist conducts a group counseling session for individuals who are enrolled in a smoking cessation program. Each individual receives a 6-minute individual counseling session as part of the group program.
5. A psychiatrist provides smoking cessation counseling to a patient who is also receiving treatment for a mental health condition. The counseling session lasts for 9 minutes and addresses the relationship between smoking and mental health.