Confidential Screening/Billing Report (PM 160) Claim Form ...
last (right) spaces of the box. For example, ICD-10-CM code J02.0 (streptococcal pharyngitis) is entered as J0200 and ICD-10-CM code J45.909 (unspecified asthma, uncomplicated asthma) is entered as J45909. Tobacco Prevention/ THE QUESTIONS BELOW MUST BE ANSWERED. Enter patient’s. Cessation Questions response to the questions concerning smoking. ................
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