(1)Tobacco treatment interventions may include one or more of these services: basic, intensive, and telephone calls.
(2)Basic tobacco cessation treatment includes the following services:
(a)Ask — systematically identify all tobacco users — usually done at each visit;
(b)Advise — strongly urge all tobacco users to quit using;
(c)Assess — the tobacco user’s willingness to attempt to quit using tobacco within 30 days;
(d)Assist — with brief behavioral counseling, treatment materials and the recommendation/prescription of tobacco cessation therapy products (e.g., nicotine patches, oral medications intended for tobacco cessation treatment and gum);
(e)Arrange — follow-up support and/or referral to more intensive treatments, if needed.
(3)When providing basic treatment, include a brief discussion to address client concerns and provide the support, encouragement, and counseling needed to assist with tobacco cessation efforts. These brief interventions, less than 6 minutes, generally are provided during a visit for other conditions, and additional billing is not appropriate.
(4)Intensive tobacco cessation treatment is on the Health Services Commission’s Prioritized List of Health Services and is covered if a documented quit date has been established. This treatment is limited to ten sessions every three months. Treatment is reserved for those clients who are not able to quit using tobacco with the basic intervention measures.
(5)Intensive tobacco cessation treatment includes the following services:
(a)Multiple treatment encounters (up to ten in a 3 month period);
(b)Behavioral and tobacco cessation therapy products (e.g., nicotine patches, oral medications intended for tobacco cessation treatment and gum);
(c)Individual or group counseling, six minutes or greater.
(6)Telephone calls: the Division may reimburse a telephone call intended as a replacement for face-to-face contact with clients who are in intensive treatment as it is considered a reasonable adjunct to, or replacement for, scheduled counseling sessions:
(a)The call must last six to ten minutes and provides support and follow-up counseling;
(b)The call must be conducted by the provider or other trained staff under the direction or supervision of the provider;
(c)Enter proper documentation of the service in the client’s chart.
(7)Diagnosis Code ICD-10-CM (F17.200-F17.299; Nicotine Dependence):
(a)Use as the principal diagnosis code when the client is enrolled in a tobacco cessation program or if the primary purpose of the visit is for tobacco cessation services;
(b)Use as a secondary diagnosis code when the primary purpose of this visit is not for tobacco cessation or when the tobacco use is confirmed during the visit.
(8)Billing Information: Coordinated care organizations and managed care plans may have tobacco cessation services and programs. This rule does not limit or prescribe services a Prepaid Health Plan provides to clients receiving OHP benefits.
Rule 410-130-0190 — Tobacco Cessation,