TOBACCO CESSATION TREATMENT - Cigna

TOBACCO CESSATION TREATMENT

Documentation and coding guide

Health care professionals are encouraged to screen patients for tobacco use. Review this guide for the

current information and CPT/HCPCS codes to document and report services for reimbursement.

Prevalence1

In 2015, 36.5 million people in the U.S.

smoked cigarettes.

In 2014, three in every 100 people used

smokeless tobacco.

Objective documentation considerations

Nicotine dependence has varying levels of

severity (mild, moderate, and severe).

Quantitative tools such as the CAGE-AID4 and

Drug Abuse Screening Test5 can help

objectively assess the level of nicotine

dependence.

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Subjective documentation considerations

The clinician needs to determine current and

past substance consumption such as:

Cigarettes

Chewing tobacco

Pipe

Nicotine gum

Passive tobacco exposure needs to

be considered

How much tobacco used (how many packs; how

many years)

Past treatment or experience with abstinence

Signs and symptoms associated with withdrawal

or tolerance

¨C Sweating or racing heart

¨C Hand trembling or seizures

¨C Insomnia

¨C Nausea or vomiting

¨C Hallucinations

¨C Restlessness and anxiety

Medical complications (dyspepsia, lung and

oral neoplasms)

Psychiatric complications (depression,

anxiety, irritability, psychosis)

Behavioral complications (temper)

Psychiatric co-morbidities

(depression, anxiety)

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Treatment plan

A majority of tobacco users desire to quit, or

have tried to quit in the past.

Treatment to cease tobacco use is successful

25% to 35% of the time.6

Prior to any treatment plan, the clinician needs

to determine a patient¡¯s willingness to stop

tobacco use and implement an accountability

strategy such as a quit date.

An effective treatment plan needs to be multidimensional in order to achieve success. Typical

interventions include:

Counseling and advisement of cessation

Pharmacotherapy ¨C over the counter and

prescriptive

¨C Nicotine replacement (inhaler, gum,

lozenge, or nasal spray)

¨C Prescriptive agent (varenicline,

bupropion, Tri-cyclic anti-depressants,

and selective serotonin re-uptake

inhibitors)

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TIP

To help ensure you are documenting to the highest degree of specificity for

appropriate ICD-10 code assignment, go to codingeducation.

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Tobacco cessation treatment

Coding and documentation considerations

Documentation of nicotine/tobacco use or

dependence is key to provide a proper code

assignment in ICD-10-CM and careful use

of terms.

ICD-10-CM codes do not exist for the following:

Tobacco abuse

History of tobacco abuse

History of tobacco use

The use of the term ¡°smoking¡¯ does not

automatically equate with use or dependence

without clear provider documentation to the

status of tobacco.

Documenting the term ¡®smoker¡¯ automatically

assumes tobacco dependence per the ICD-10-CM

alphabetic index.

Simply documenting ¡®Packs per day¡¯ or ¡®Number

of years¡¯ does not automatically assume a status

of tobacco/nicotine dependence without clear

provider documentation to the status.

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References:

1. Centers for Disease Control and Prevention [CDC].

(2015). Smoking and tobacco use ¨C fast facts

(webpage). Retrieved from

tobacco/data_statistics/fact_sheets/index.htm

2. Centers for Disease Control and Prevention [CDC].

(2014). Smokeless tobacco use in the United States

(webpage). Retrieved from

tobacco/data_statistics/fact_sheets/smokeless

/use_us/

3. U.S. Department of Health and Human Services

[USDHHS]. The Health Consequences of Smoking¡ª50

Years of Progress: A Report of the Surgeon General.

(2014). Atlanta: U.S. Department of Health and Human

Services, Centers for Disease Control and Prevention,

National Center for Chronic Disease Prevention and

Health Promotion, Office on Smoking and Health.

Retrieved from

statistics/sgr/50th-anniversary/index.htm

4. Brown, R. (n.d.). CAGE-aid [website]. Retrieved from



CAGEAID.pdf

5. Skinner, H. (1982). The drug abuse screening test.

Addictive Behavior, 7(4),363¨C371. Retrieved from



DAST-10.pdf

6. Anthenelli R. et al. (2016). Neuropsychiatric safety and

efficacy of varenicline, bupropion, and nicotine patch

in smokers with and without psychiatric disorders

ICD-10-CM

ICD-10-CM Code

ICD-10-CM Description

F17.20 -

Nicotine dependence, unspecified

F17.21 -

Nicotine dependence, cigarettes

F17.22 -

Nicotine dependence, chewing tobacco

F17.29 -

Nicotine dependence, other tobacco products

Z57.31

Occupational exposure to environmental tobacco smoke

Z71.6

Tobacco abuse counseling

Z72.0

Tobacco Use NOS

Z87.891

Personal history of nicotine dependence

Definition/tip

(-) Add 6th character:

0 ¨C uncomplicated

1 ¨C in remission

3 ¨C w/withdrawal

8 ¨C w/other nicotine-induced disorders

9 ¨C w/unspecified nicotine-induced

disorders

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