WHO’s ‘World No Tobacco Day’ Calls for Plain Packaging for Tobacco Products

World no tobacco day, WHO, plain packaging, smoking-related diseases, damaged lungs, smoking cessation, coding smoking cessation

If you’re of a certain age, some television cigarette advertisements are still vivid in your mind. I hated breathing the ubiquitous second-hand cigarette smoke of the 1960s, but I loved the Marlboro Man advertisements, and I missed them when they left the airwaves due to federal mandate on January 2, 1971. Since then, at least four of the Marlboro Men died of smoking-related diseases, and their iconic image is no longer used to sell conventional cigarettes.

No matter what, the selling power of advertising, images, and packaging is well documented, so just imagine a world where cigarette boxes are festooned not with positive imagery but rather with graphic illustrations of the end effects of smoking-related illnesses.

No More Pretty Packages for Cigarettes, Says World Health Organization

The World Health Organization’s 2016 World No Tobacco Day is May 31, and to mark the day, WHO asks all countries to adopt standardized plain packaging for tobacco products. According to WHO, plain packaging restricts the use of logos, colors, brand images, or promotional information on the packaging, thus decreasing demand for the product. Plain packaging rules allow only display of brand and product names in a standard color and font style. Also, many plain packaging regulations require the use of graphic imagery illustrating the dangers of smoking, including damaged lungs, injured eyes, and limbs oozing and inflamed from peripheral vascular disease.

Australia Leads the Pack, Great Britain Right Behind

In 2011, Australia became the first developed nation to require plain packaging for tobacco products, sparking lawsuits at the World Trade Organization from tobacco companies claiming the plain packaging law violates their intellectual property. The British government followed in 2015 with a requirement for plain packaging for tobacco products starting this year, despite legal challenges already in the works. Ireland and France were also considering adopting plain-packaging measures.

Don’t Hold Your Breath for Plain Packaging in the U.S.

As recently as 2011, The Food and Drug Administration tried to require cigarette packaging to include large graphic labels illustrating the damage smoking causes on the human body. Tobacco manufacturers sued to block the order, an appeals court ruled that requiring these labels would violate First Amendment free speech protections, and the FDA abandoned the idea in 2013.

FDA Announces E-Cigarette Regulation Requirement

The FDA announced in early May that it would require all e-cigarettes on the market since 2007 to file for approval by the agency, and at least one vaping product manufacturer has sued the agency over these regulations. People who “vape” their nicotine use electronic delivery systems to inhale vaporized doses of nicotine infused with flavorings and other chemicals.

Learn to Report Smoking Cessation Counseling Efforts

Though plain packaging may not be coming to American cigarette packages any time soon, Medicare and private payers support cessation efforts by doctors and qualified health professionals. For example, imagine a patient comes into the office for a problem-related visit, such as a cough and sinus infection. Your provider documents an expanded problem-focused history, expanded problem-focused exam, and low complexity medical decision-making. The patient admits she still smokes, and the provider discusses possible treatment plans, telling the patient that quitting smoking will make the treatment plan more effective. The patient agrees to try, and the smoking cessation counseling starts.

Reporting Smoking Cessation to Private Payers

How do you report this? For a non-Medicare patient, report 99213 (Office or other outpatient visit for the evaluation and management of an established patient…) for the problem-based visit, then report 99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) or 99407 (… intensive, greater than 10 minutes) for the smoking cessation counseling. Also attach modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to the E/M service to tell the payer your provider has earned payment for both the problem-oriented E/M and the counseling service.

For Most Medicare Efforts, Turn to G Codes

For asymptomatic Medicare patients undergoing smoking cessation counseling, choose G0436 (Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes) or G0437 (… intensive, greater than 10 minutes). Medicare uses the G codes to distinguish preventive counseling from the therapeutic kind, which is reserved for patients with symptoms caused by smoking. For therapeutic counseling for Medicare patients, you’d use 99406 and 99407.

How About You?

My day job is at an acute-care inpatient facility, and boy, do we see a lot of smoking cessation discussions in our H&Ps. Do your providers do much smoking cessation counseling? Let us know in the comment box below.

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Susan taught health information and healthcare documentation at the community college level for more than 20 years. She has a special love for medical language and terminology. She is passionate about ensuring accurate patient healthcare documentation through education. She has a master's degree in healthcare administration, is a certified healthcare documentation specialist, and serves as immediate past president for the Association for Healthcare Documentation Integrity (AHDI).

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