Adding Ancillaries: Counseling for smokers

You've doubtless lost track of how often you've advised patients to lay off cigarettes. You might even have devoted a good chunk of "quit or else" time to someone who looked to be only a few puffs shy of COPD or emphysema. Now, Medicare will pay you for up to eight tobacco-cessation counseling sessions per patient per year, provided that the sessions are longer than three minutes each and the patient has a tobacco-related illness or is taking a medicine that interacts adversely with tobacco. Separate appointments aren't necessary: If the patient meets the criteria, you can bill for tobacco-cessation counseling that's provided during a regular E&M visit.

Like nutritional counseling, this isn't a lucrative ancillary, but it gives you a chance to collect for a service you're probably offering anyway. It also helps cement patient loyalty and can be a practice builder if patients tell friends that you were instrumental in freeing them from tobacco's grip.

"Medicare hasn't given specific guidelines as to the content of the counseling," says Dianne Wilkinson, compliance officer and quality manager for MedSouth Healthcare in Dyersburg, TN. But she points out that most experts recommend the five-A's approach:

A date more than six weeks in the future indicates that the patient isn't serious about quitting, says Glynn, who doesn't recommend the cold-turkey route. "People who make a spur-of-the-moment decision to stop smoking usually aren't as successful as those who take time to prepare for it," he notes. He does recommend appropriate medication-bupropion SR, or nicotine gum, inhaler, nasal spray, patch, or lozenges-and stresses the importance of telling patients how to use the drug correctly. Stress the fact that smoking isn't a habit, it's an addiction.