Medicare Summary Notice

[incidentally]

I just received a Medicare Summary Notice for Doctor related service in July.

There are two codes, that I don't ever remember seeing before. They are:

tobacco non-user (1036F)
cur tobacco non-user (G8457)

Charge $0.00

Note: This code is for informational purposes only. You should not be charged for this code. If there is a charge, you do not have to pay the amount.

Does anyone know when Medicare started keeping track of smokers (tobacco users) vs. non-smokers (non-tobacco users)?

[ortiga]

I just received a Medicare Summary Notice for Doctor related service in July.

There are two codes, that I don't ever remember seeing before. They are:

tobacco non-user (1036F)
cur tobacco non-user (G8457)

Charge $0.00

Note: This code is for informational purposes only. You should not be charged for this code. If there is a charge, you do not have to pay the amount.

Does anyone know when Medicare started keeping track of smokers (tobacco users) vs. non-smokers (non-tobacco users)?

what does "cur" mean? Is that a typo?

[incidentally]

what does "cur" mean? Is that a typo?

Hi ortiga,

No, that's what is typed on the summary. I was assuming maybe chewing tobacco or snuff?

ETA: I just looked it up in a search and the code apparently means:

G8457 - CURRENT TOBACCO NON-USER

[desmom]

I just received a Medicare Summary Notice for Doctor related service in July.

There are two codes, that I don't ever remember seeing before. They are:

tobacco non-user (1036F)
cur tobacco non-user (G8457)

Charge $0.00

Note: This code is for informational purposes only. You should not be charged for this code. If there is a charge, you do not have to pay the amount.

Does anyone know when Medicare started keeping track of smokers (tobacco users) vs. non-smokers (non-tobacco users)?

A google search for 1036F and for G8457 brought 500+ hits dating back to 2006. The most recent report I found is here: http://www.facs.org/ahp/pqri/2009/2009measuresgroupspecsmanual.pdf

Regarding the codes on your statement. From the above link:

Tobacco Use Assessed
(Two CPT II codes [1000F & 103xF] are required on the claim form to submit this numerator option)
CPT II 1000F: Tobacco use assessed
AND
CPT II 1034F: Current tobacco smoker
OR
CPT II 1035F: Current smokeless tobacco user
OR
CPT II 1036F: Current tobacco non-user

-------------------------------------------------------------------
If patient is not eligible for this measure because patient is a smokeless tobacco user or a non tobacco user, report:
(One G-code [G845x] is required on the claim form to submit this numerator option)
Smokeless Tobacco User
G8456: Current smokeless tobacco user
OR
Tobacco Non-User
G8457: Current tobacco non-user

[incidentally]

Hi desmon,

Thanks for the link.

In this "2009 Physician Quality Reporting Initiative
Measures Groups Specifications Manual" it states, in part:

Professionals who satisfactorily report under more than one reporting option will receive a maximum of one incentive payment, which will be equivalent to 2.0% of their PFS allowed charges for all covered professional services furnished,

Interesting. Now I need to dig out my other bills and double check to see if those doctors are reporting my smoking/nonsmoking status.

[ortiga]

Hi desmon,

Thanks for the link.

In this "2009 Physician Quality Reporting Initiative
Measures Groups Specifications Manual" it states, in part:



Interesting. Now I need to dig out my other bills and double check to see if those doctors are reporting my smoking/nonsmoking status.

wow, that's confusing. Does it mean that the doctor gets an "incentive payment" if it's harder to treat someone if they DO smoke, or opposite...they get an incentive payment if they possibly convince the person to not smoke?

I'm not on medicare yet, but doctors always do ask me if I smoke, and look doubtful when I say "never have", which is true.

[incidentally]

wow, that's confusing. Does it mean that the doctor gets an "incentive payment" if it's harder to treat someone if they DO smoke, or opposite...they get an incentive payment if they possibly convince the person to not smoke?

I'm not on medicare yet, but doctors always do ask me if I smoke, and look doubtful when I say "never have", which is true.

It is very strange. I was thinking they may not aggressively treat some diseases if the person smokes and does not agree to quit.

According to desmom's link, it has been being reported, in one form or another, over the last few years.

[incidentally]

I am wondering if you may not be right - I can't think of another explanation anyway.

I am going to check with my mom since she smokes, and see if she has a "smoking code" as well.

That would be great, if you would.

[desmom]

wow, that's confusing. Does it mean that the doctor gets an "incentive payment" if it's harder to treat someone if they DO smoke, or opposite...they get an incentive payment if they possibly convince the person to not smoke?

I'm not on medicare yet, but doctors always do ask me if I smoke, and look doubtful when I say "never have", which is true.

Could it be a way to collect data re smoking related diseases? i.e. heart disease - smoker vs non-smoker

:shrug:

[incidentally]

This is the first time I have noticed it. I'll have to go through my summary sheets and see if I notice it with any other doctors.

[Spyder88]

I just received a Medicare Summary Notice for Doctor related service in July.

There are two codes, that I don't ever remember seeing before. They are:

tobacco non-user (1036F)
cur tobacco non-user (G8457)

Charge $0.00

Note: This code is for informational purposes only. You should not be charged for this code. If there is a charge, you do not have to pay the amount.

Does anyone know when Medicare started keeping track of smokers (tobacco users) vs. non-smokers (non-tobacco users)?

Got any 800-MEDICARE Cares phone numbers listed anywhere on that summary notice? I'd have to call them. :shrug:

[incidentally]

Got any 800-MEDICARE Cares phone numbers listed anywhere on that summary notice? I'd have to call them. :shrug:

Hi Spyder,

Yes it does have that number under General Information but the person I spoke to only repeated what is listed on my Summary sheet, that "it's for informational purposes only".

[Rucky*Ron]

Sounds suspiciously like a code to deny services for smokers in the future.

Kind of like how paid insurance denies services for "an existing" condition.

MOO

[Lady_Jean_La]

It is very strange. I was thinking they may not aggressively treat some diseases if the person smokes and does not agree to quit.

According to desmom's link, it has been being reported, in one form or another, over the last few years.It is dangerous for smokers to take some medications which may cause blood clots.

imo

[Lady_Jean_La]

http://www.aan.com/globals/axon/assets/4962.pdf

[incidentally]

http://www.aan.com/globals/axon/assets/4962.pdf

:glare:.............

[warhorse46]

It is dangerous for smokers to take some medications which may cause blood clots.

imo


That is very true but that is the Doctor's business, not Medicare's IMO. I looked on my Medicare statements & cannot find any code like the one listed but I don't have any for doctor visits, just ones for lab work, x-rays, doppler studies & an MRI.

[Spyder88]

Hi Spyder,

Yes it does have that number under General Information but the person I spoke to only repeated what is listed on my Summary sheet, that "it's for informational purposes only".

I'd call back and tell them I want to know what information purpose it's for...e-x-a-c-t-l-y. If the customer service person can't answer, then ask to speak to their supervisor.

I'm not unlike a dog with a bone if I want to know something and nobody's cooperating. I get a lil' irkitated and then I get downright cranky and obstinate. Not my best quality, but it serves it's purpose every now and again.

:smile:

[ViennaGal]

I asked my boss about this. He is a corporate attorney for an insurance brokerage. He has worked in healthcare law for 25 or 30 years. He said he had never heard about this before and was somewhat shocked. He also said, they might say it's for informational purposes only but he said that was suspect. The information will be used in some form or fashion or it wouldn't be being done. That is just his opinion.

[warhorse46]

I asked my boss about this. He is a corporate attorney for an insurance brokerage. He has worked in healthcare law for 25 or 30 years. He said he had never heard about this before and was somewhat shocked. He also said, they might say it's for informational purposes only but he said that was suspect. The information will be used in some form or fashion or it wouldn't be being done. That is just his opinion.




I agree with your boss, it is very suspect.

[incidentally]

I'd call back and tell them I want to know what information purpose it's for...e-x-a-c-t-l-y. If the customer service person can't answer, then ask to speak to their supervisor.

I'm not unlike a dog with a bone if I want to know something and nobody's cooperating. I get a lil' irkitated and then I get downright cranky and obstinate. Not my best quality, but it serves it's purpose every now and again.

:smile:

I'd run out of my monthly cell phone minutes. It took me over 20 minutes before I got a representative the first time.

[incidentally]

I asked my boss about this. He is a corporate attorney for an insurance brokerage. He has worked in healthcare law for 25 or 30 years. He said he had never heard about this before and was somewhat shocked. He also said, they might say it's for informational purposes only but he said that was suspect. The information will be used in some form or fashion or it wouldn't be being done. That is just his opinion.

Did you show your boss the links that have been posted here? They make things seem even more suspect.

[ViennaGal]

Boss and I googled this because now his curiosity is up and only found a few articles about Medicare now covering smoking cessation programs.

[ViennaGal]

Did you show your boss the links that have been posted here? They make things seem even more suspect.

I've printed them Tally but he hasn't had a chance to look at them.

[incidentally]

I've printed them Tally but he hasn't had a chance to look at them.

Thank you, VG.

[ViennaGal]

Thank you, VG.

I printed the Preventive Care and Screening sheets for him and he's a smoker. All he said was it's BS and that since it is NCQA rules not much we can do about it but thank our government.

[incidentally]

I printed the Preventive Care and Screening sheets for him and he's a smoker. All he said was it's BS and that since it is NCQA rules not much we can do about it but thank our government.

Thank you, VG, that accurately describes my thoughts as well.

[ViennaGal]

Thank you, VG, that accurately describes my thoughts as well.

I threw my two cents in and said how much of it could be to keep sue happy people from suing the tobacco companies when a loved ones dies. It would show their physician was vigilant in trying to get them to quit. He said, eh, maybe. This way there is proof the individual was not only warned by the warning on the packaging but by their physicians. :glare:

[incidentally]

I threw my two cents in and said how much of it could be to keep sue happy people from suing the tobacco companies when a loved ones dies. It would show their physician was vigilant in trying to get them to quit. He said, eh, maybe. This way there is proof the individual was not only warned by the warning on the packaging but by their physicians. :glare:

Why would the tobacco companies and Medicare be in cahoots, so to speak?

[ViennaGal]

Why would the tobacco companies and Medicare be in cahoots, so to speak?

They wouldn't that is why he said, Eh. LOL! I was over thinking it. I have searched www.medicare.gov and can't find anything. I even called one of our Team Managers who knows Medicare and she wasn't even aware of this and the new CPT codes but she doesn't deal with it much any more.

[incidentally]

They wouldn't that is why he said, Eh. LOL! I was over thinking it. I have searched www.medicare.gov and can't find anything. I even called one of our Team Managers who knows Medicare and she wasn't even aware of this and the new CPT codes but she doesn't deal with it much any more.

It talks about incentive programs for doctors who participate in this coding and then in another pdf it says it must be reported and then gives the time frames in order to report.

[incidentally]

Are you, in fact, currently a non-user? I know- its non of our business either..... but I'm just hoping its true.

That is what makes it even more baffling. Currently, I am a non-smoker BUT on the date of that appointment, I was a still smoking (relapsed smoker after 30 day quit) and the doctor has always known me as a smoker. He never asked anything about whether I was or was not smoking at the time of the visit.

That leads me to another question. Exactly when is one considered a non-smoker? Within 24 hours of not smoking..a week..a month..a year?