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Tobacco Use and Dependence Guideline Panel. Treating Tobacco Use and Dependence: 2008 Update. Rockville (MD): US Department of Health and Human Services; 2008 May.

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Treating Tobacco Use and Dependence: 2008 Update.

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Appendix CCoding Information Regarding the Diagnosis of and Billing for Tobacco Dependence Treatment

Coding for the Treatment of Tobacco Use

Clinicians, clinic administrators, and health care delivery systems require appropriate diagnostic and billing codes for the documentation and reimbursement of tobacco dependence treatment. Information on such codes may help address a common clinical concern regarding the treatment of tobacco-dependent patients: it is difficult to accurately document and obtain reimbursement for this treatment. Although examples of such codes are provided below, clinicians and billing coders may use other diagnostic and reimbursement codes to document and obtain payment for this medical treatment. Additionally, it is incumbent on the clinician to ensure that appropriate billing guidelines are followed and to recognize that reimbursement of these codes may vary by payor or benefits package. For example, although psychiatric therapeutic codes appropriate for treating tobacco dependence exist, some payors or benefits packages have restrictions on mental health benefits. Similarly, reimbursement for preventive visits varies greatly among payors and benefits packages.

A systems-based approach will facilitate the understanding and use of such codes by clinicians. For example, various clinic or hospital meetings (e.g., business sessions, grand rounds, seminars, and coding in-service sessions) can explain and highlight the use of tobacco dependence codes for diagnosis and reimbursement. Additionally, these diagnostic codes can be preprinted on the billing and diagnostic coding sheets as a “check-off” so that clinicians are not required to recall and manually document such treatment. Finally, clinicians can be reminded that counseling by itself is a reimbursable activity and can be billed-for based on the number of minutes of counseling.

1. Diagnostic Codes (ICD-9-CM)

When clinicians provide treatment to patients dependent on tobacco, the following diagnostic codes can be used. They can be found in the ICD-9-CM (International Classification of Diseases, 9th Revision, Clinical Modification) coding manual under several sections:

Mental Disorders (290–319)

305.1 Tobacco Use Disorder (Tobacco Dependence). Cases in which tobacco is used to the detriment of a person's health or social functioning or in which there is tobacco dependence. Tobacco dependence is included here rather than under drug dependence because tobacco differs from other drugs of dependence in its psychotropic effect. This excludes: History of tobacco use (V15.82).

V Codes

V15.82 History of Tobacco Use. This excludes: Tobacco dependence (305.1).

Diseases of Oral Cavity, Salivary Glands, and Jaws

523.6 Accretions on teeth

Supragingival: Deposits on teeth: tobacco.

Accidental Poisoning by Other Solid and Liquid Substances, Gases, and Vapors

E869.4 Secondhand tobacco smoke.

Complications Mainly Related To Pregnancy

649.0 Tobacco use disorder complicating pregnancy, childbirth, or the puerperium.

2. Billing Codes (Current Procedural Terminology [CPT] Codes)

A number of billing codes may be used for reimbursement of the provision of tobacco dependence treatment. The examples provided fall under the general categories of preventive medicine services, psychiatric therapeutic procedures, and dental codes.

A. Preventive Medicine Services

The following codes are used to report the preventive medicine evaluation and management of infants, children, adolescents, and adults.

The “comprehensive” nature of the Preventive Medicine Services codes 99383–99397 reflects an age- and gender-appropriate history/exam and is NOT synonymous with the “comprehensive” examination required in Evaluation and Management codes 99201–99350.

Codes 99383–99397 include counseling/anticipatory guidance/risk factor reduction interventions, which are provided at the time of the initial or periodic comprehensive preventive medicine examination. (Refer to codes 99401–99412 for reporting those counseling/anticipatory guidance/risk factor reduction interventions that are provided at an encounter separate from the preventive medicine examination.)

A1. Initial or Periodic Comprehensive Preventive Medicine Examination

New Patient

99383 Initial comprehensive preventive medicine.

Initial comprehensive preventive medicine evaluation and management of an individual, including an age and gender-appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunization(s), laboratory/diagnostic procedures, new patient; late childhood (age 5 through 11 years).

99384 Adolescent (age 12–17 years).

99385 Adult (age 18–39 years).

99386 Adult (age 40–64 years).

99387 Adult (age 65 years and older).

Established Patient

99393 Periodic comprehensive preventive medicine.

Reevaluation and management of an individual, including an age- and gender-appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunization(s), laboratory/diagnostic procedures, established patient; late childhood (age 5 through 11 years).

99394 Adolescent (age 12–17 years).

99395 Adult (age 18–39 years).

99396 Adult (age 40–64 years).

99397 Adult (age 65 years and older).

A2. Counseling and/or Risk Factor Reduction Intervention

These codes are used to report services provided to individuals at a separate encounter for the purpose of promoting health and preventing illness or injury. As such, they are appropriate for the specific treatment of tobacco use and dependence. They are appropriate for initial or followup tobacco dependence treatments (new or established patient). For the specific preventive medicine counseling codes, the number of minutes counseled determines the level of billing (codes 99400–99404 for 15 to 60 minutes of counseling).

Preventive Medicine, Individual Counseling

99401 Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes.

99402 Approximately 30 minutes.

99403 Approximately 45 minutes.

99404 Approximately 60 minutes.

Smoking Cessation Counseling

These codes are for face-to-face counseling by a physician or other qualified health care professional, using “standardized, evidence-based screening instruments and tools with reliable documentation and appropriate sensitivity.”

99406 For intermediate visit of between 3 and 10 minutes.

99407 For an intensive visit lasting longer than 30 minutes.

Preventive Medicine, Group Counseling

99411 Preventive medicine counseling and/or intervention to treat the risk factor of tobacco use provided to an individual (separate procedure); approximately 30 minutes.

99412 Approximately 60 minutes.

B. Psychiatric Therapeutic Procedures/Codes for Billing

The psychiatric therapeutic procedure billing codes are typically used for insight-oriented, behavior modifying, and/or supported psychotherapy. This refers to the development of insight of affective understanding, the use of behavior modification techniques, the use of supportive interactions, the use of cognitive discussion of reality, or any combination of the above to provide therapeutic change. All of the counseling interventions for tobacco dependence demonstrated to be effective in this Guideline fall under these headings.

It should be noted that these billing codes can be modified for those patients receiving only counseling (psychotherapy) and for others that receive counseling (psychotherapy), medical evaluation, and management services. These evaluation and management services involve a variety of responsibilities unique to the medical management of psychiatric patients, such as medical diagnostic evaluation (e.g., evaluation of comorbid medical conditions, drug interactions, and physical examinations); drug management when indicated; physician orders; and interpretation of laboratory or other medical diagnostic studies and observations. Thus, the use of a psychiatric therapeutic billing code with medical evaluation and management services would be appropriate for the clinician who provides both of the key tobacco dependence interventions documented as effective in the Guideline: counseling and medications.

In documenting treatment for tobacco dependence using the psychiatric therapeutic procedure codes, the appropriate code is chosen on the basis of the type of psychotherapy (e.g., insight-oriented, behavior modifying, and/or supportive using verbal techniques); the place of service (office vs. inpatient); the face-to-face time spent with the patient during the treatment (both for psychotherapy and medication management); and whether evaluation and management services are furnished on the same date of service as psychotherapy.

B1. Office or Other Outpatient Facility

Insight-oriented, behavior modifying, and/or supportive psychotherapy.

90804 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient.

90805 With medical evaluation and management services.

90806 Individual psychotherapy, insight-oriented, behavior modifying, and/or supportive, in an office or outpatient facility, approximately 45 to 50 minutes face-to-face with the patient.

90807 With medical evaluation and management services.

90808 Individual psychotherapy, insight-oriented, behavior modifying, and/or supportive, in an office or outpatient facility, approximately 75 to 80 minutes face-to-face with the patient.

90809 With medical evaluation and management services.

B2. Inpatient Hospital, Partial Hospital, or Residential Care Facility

Insight-oriented, behavior modifying, and/or supportive psychotherapy.

90816 Individual psychotherapy, insight-oriented, behavior modifying, and/or supportive, in an inpatient hospital, partial hospital, or residential care setting, approximately 20 to 30 minutes face-to-face with the patient.

90817 With medical evaluation and management services.

90818 Individual psychotherapy, insight-oriented, behavior modifying, and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 45 to 50 minutes face-to-face with the patient.

90819 With medical evaluation and management services.

90821 Individual psychotherapy, insight-oriented, behavior modifying, and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 75 to 80 minutes face-to-face with the patient.

90822 With medical evaluation and management services.

B3. Other Psychotherapy

90853 Group psychotherapy (other than a multiple-family group).

C. Dental Code -CDT Codes

D1320 Tobacco counseling for the control and prevention of oral disease.

Please Note: The following section is included for informational purposes only.

The National Center for Health Statistics (NCHS), the Federal agency responsible for use of the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) in the United States, has developed a clinical modification of the classification for morbidity purposes. The ICD-10 is used to code and classify mortality data from death certificates, having replaced ICD-9 for this purpose as of January 1, 1999. ICD-10-CM is planned as the replacement for ICD-9-CM, volumes 1 and 2.

An updated July 2007 release of ICD-10-CM is available for public viewing. However, at the time of this printing, the codes in ICD-10-CM are not currently valid for any purpose or use other than mortality coding. Once implemented, this information must be validated as current before use.

F17 Nicotine dependence

Excludes1: history of tobacco dependence (Z87.82) tobacco use NOS (Z72.0) Excludes2: tobacco use (smoking) during pregnancy, childbirth, and the puerperium (O99.33-) toxic effect of nicotine (T65.2-).

F17.2 Nicotine dependence

F17.20 Nicotine dependence, unspecified
F17.200 Nicotine dependence, unspecified, uncomplicated
F17.201 Nicotine dependence, unspecified, in remission
F17.203 Nicotine dependence, unspecified, with withdrawal nicotine-induced disorders
F17.209 Nicotine dependence, unspecified, with unspecified nicotine-induced disorders
F17.21 Nicotine dependence, cigarettes
F17.210 Nicotine dependence, cigarettes, uncomplicated
F17.211 Nicotine dependence, cigarettes, in remission
F17.213 Nicotine dependence, cigarettes, with withdrawal
F17.218 Nicotine dependence, cigarettes, with other nicotine-induced disorders
F17.219 Nicotine dependence, cigarettes, with unspecified nicotine-induced disorders
F17.22 Nicotine dependence, chewing tobacco
F17.220 Nicotine dependence, chewing tobacco, uncomplicated
F17.221 Nicotine dependence, chewing tobacco, in remission
F17.223 Nicotine dependence, chewing tobacco, with withdrawal
F17.228 Nicotine dependence, chewing tobacco, with other nicotine-induced disorders
F17.229 Nicotine dependence, chewing tobacco, with unspecified nicotine-induced disorders
F17.29 Nicotine dependence, other tobacco product
F17.290 Nicotine dependence, other tobacco product, uncomplicated
F17.291 Nicotine dependence, other tobacco product, in remission
F17.293 Nicotine dependence, other tobacco product, withwithdrawal
F17.298 Nicotine dependence, other tobacco product, with other nicotine-induced disorders
F17.299 Nicotine dependence, other tobacco product, with unspecified nicotine-induced disorders

O99.3 Mental disorders and diseases of the nervous system complicating pregnancy, childbirth, and the puerperium

O99.33 Smoking (tobacco) complicating pregnancy, childbirth, and the puerperium

Use additional code from F17 to identify type of tobacco.
O99.330 Smoking (tobacco) complicating pregnancy, unspecified trimester
O99.331 Smoking (tobacco) complicating pregnancy, first trimester
O99.332 Smoking (tobacco) complicating pregnancy, second trimester
O99.333 Smoking (tobacco) complicating pregnancy, third trimester
O99.334 Smoking (tobacco) complicating childbirth
O99.335 Smoking (tobacco) complicating the puerperium

T65 Toxic effect of other and unspecified substances

T65.2 Toxic effect of tobacco and nicotine

Excludes2: nicotine dependence (F17.-).
T65.21 Toxic effect of chewing tobacco
T65.211 Toxic effect of chewing tobacco, accidental (unintentional)
Toxic effect of chewing tobacco NOS
T65.212 Toxic effect of chewing tobacco, intentional self-harm
T65.213 Toxic effect of chewing tobacco, assault
T65.214 Toxic effect of chewing tobacco, undetermined
T65.22 Toxic effect of tobacco cigarettes
Toxic effect of tobacco smoke
Use additional code for exposure to secondhand tobacco smoke (Z57.31, Z58.7).
T65.221 Toxic effect of tobacco cigarettes, accidental (unintentional)
Toxic effect of tobacco cigarettes NOS
T65.222 Toxic effect of tobacco cigarettes, intentional self-harm
T65.223 Toxic effect of tobacco cigarettes, assault
T65.224 Toxic effect of tobacco cigarettes, undetermined
T65.29 Toxic effect of other tobacco and nicotine
T65.291 Toxic effect of other tobacco and nicotine, accidental (unintentional)
Toxic effect of other tobacco and nicotine NOS
T65.292 Toxic effect of other tobacco and nicotine, intentional self-harm
T65.293 Toxic effect of other tobacco and nicotine, assault
T65.294 Toxic effect of other tobacco and nicotine, undetermined

Z71 Persons encountering health services for other counseling and medical advice, not elsewhere classified

Z71.6 Tobacco abuse counseling
Use additional code for nicotine dependence (F17.-).

Z72 Problems related to lifestyle

Z72.0 Tobacco use
Tobacco use NOS
 Excludes1: history of tobacco dependence (Z87.82), nicotine dependence (F17.2-), tobacco dependence (F17.2-), tobacco use during pregnancy (O99.33-).

Z87 Personal history of other diseases and conditions

Z87.8 Personal history of other specified conditions
Z87.82 Personal history of nicotine dependence
 Excludes1: current nicotine dependence (F17.2-).

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