Smoking Cessation Codes E079 & K039

We received a request through our chat forum (http://www.ombis.ca/) to breakdown the smoking cessation codes - so here goes!

The most confusion we have encountered when it comes to these codes is the order and appropriateness of the billing.  Before K039 can be billed you MUST first bill E079 but it isn't as simple as just billing E079.  E079 is billed in conjunction with another code (i.e. A001, A003, A007 - see billing modules for more associated codes).  The reason that the E079 has to be billed first is because E079 is for the initial discussion with the patient regarding smoking cessation and this initial conversation would generally be raised by the physician while the patient was attending clinic for another reason.  E079 is to be rendered by the primary care physician most responsible for the patient's ongoing care and, obviously, to a patient who currently smokes.  E079 is limited to a maximum of one service per patient, per 12 month period.

In terms of record keeping, the medical record must document that an initial smoking cessation discussion has taken place, by either completion of a flow sheet (smoking cessation flow sheet) or other documentation consistent with the most current guidelines of the Clinical Tobacco Intervention program or this service is NOT eligible for payment. Physicians may complete the flow sheet or alternatively document that an initial discussion consistent with the 5A's model of the CTI program has taken place.

Once you have seen the patient for the initial discussion (and appropriately documented as noted above) and billed E079 you can now have the patient book for their smoking cessation appointment for followup following which, you will be able to bill K039.  "Smoking Cessation Follow-Up Visit" is the service rendered by a primary care physician in the 12 months following E079.  The K039 appointment is dedicated to a discussion of smoking cessation, in accordance with the guidelines.  The same charting conditions as noted in the paragraph above for E079 also apply for K039.

K039 is only eligible for payment when E079 is payable (and has been paid) to the same physician in the preceding 12 month period.  K039 is limited to a maximum of two services in the 12 months following E079.
Both E079 and K039 are outside of the basket for FHO and FHN physicians.

It has been noted that some physicians are having difficulty claiming E079 with certain diagnostic codes and the MOHLTC is currently working to resolve this. A notice will be issues with any forthcoming information regarding this issue and updates will be posted on the OMA website.  *We haven't received a recent update on this issue and we are unsure as to the current status.

A good resource to find the required form and/or charting criteria noted above is  http://www.omacti.org/