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What "Patient Counseling" Of Smoking Cessation Is Worth

Armen Hareyan's picture

Effective Jan 1, 2008, there are two codes that doctors can use for "Smoking and tobacco use cessation counseling visit: intermediate, up to ten minutes (99406)" and "greater than 10 minutes (99407)". The reimbursement for 99406 is $11.96 and for 99407 it is $23.55. (Yes, you saw those numbers correctly. I can't wait to get my check for $11.96)

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Smoking is one of the most detrimental of bad health habits and it costs each American $630 a year in federal and state taxes for the public health of smoking related problems. A pack of cigarettes costs $4.49 and a 40-year-old who quits smoking and puts the savings into a 401(k) earning 9% a year would have nearly $250,000 by age 70. So how much is primary care counseling really worth to society?

Why is something that should be valued...helping patients quit smoking...reimbursed pennies, yet a CT of the lung to check for cancer can be reimbursed over $2,000.00. Add on pulmonary consults, PET scans, follow up CTs, and Chest X-rays to evaluate a lung nodule and you can be up to $25,000 in no time at all. That is all just "screening"...not even a diagnosis or treatment.

What does this tell us? Primary care is dead in the United States and our health system is imploding with misaligned incentives and payments. The $11.96 that Medicare pays a primary care physician will buy 2 packs of cigarettes with change left over for a donut.