The simple answer to how to quit tobacco is that there is no simple answer. Different methods work for different people, and no two paths to quitting are the same. Often, several attempts are needed before the right method is found. However, as a healthcare provider, the best thing you can do for your patients is to recommend they quit, point them in the direction of proven cessation methods, and provide the encouragement and inspiration needed to help them stick with it.
APPROACHING PATIENTS ABOUT TOBACCO CESSATION
Though primary care providers are in an excellent position to provide tobacco cessation interventions with their patients who use tobacco products, it can be difficult and sometimes uncomfortable to approach the topic. We recommend treating tobacco use as a vital sign so that a patient’s tobacco use status is readily apparent upon their entrance into the exam room. This is an easy way to integrate conversations about tobacco use into the clinic visit. Tobacco use can be a chronic, relapsing condition that at times requires varying levels of intervention. We encourage you to go as far as you can with each patient at each visit as you help lay the groundwork for tobacco cessation.
In order to assess your patient’s level of nicotine dependence, we suggest using the test in Fagerström Test for Nicotine Dependence. The level of your patient’s nicotine dependence has important indications for the regimen that should be suggested for treatment.
It can be difficult to know what to say to your patient, here are some simple scripts for your use.
The Utah Tobacco Quit Line
English: 1.800.QUIT.NOW (1.800.784.8669)
Spanish: 1.855.DÉJELO.YA (1.855.335.3569)
Hours of operation: 24 hours a day, 7 days a week
Believe it or not, telephone counseling is one of the most effective ways to help people quit smoking or chewing tobacco. In contrast to in-person counseling, it eliminates the need for transportation and childcare, as a person can access services from wherever there’s a telephone. Help can be obtained on the person’s own timetable and terms, and critical assistance is just a phone call away.
When someone calls the Utah Tobacco Quit Line, they can:
Quit line services are completely confidential and available in English and Spanish. Translation is also available into more than a hundred other languages. All services are free to Utah residents.
Check here to determine if free promotional materials are available at your local health department.
Online Coaching is a free, internet-based service designed to help individual tobacco users through the quitting process. Its interactive tools and features can be used 24 hours a day, seven days a week, for as long as needed. At any time, tobacco users can log on for information and support. Utah online coaching members can take advantage of:
All these services are free to Utah users. Online coaching can be used alone or in combination with other services, like the Utah Tobacco Quit Line, for added support.
Utah Tobacco Cessation Resource Directory
The Utah Tobacco Cessation Resource Directory is provided as a public service by the Utah Department of Health Tobacco Prevention and Control Program. The purpose of the directory is to assist tobacco users and health professionals in locating tobacco cessation resources in their local area. We encourage you to contact these agencies or programs if you are interested in more specific information about the length, content and cost (if any) of programs.
In Utah, the Medicaid system is part of the Department of Health. Medicaid clients tend to have higher smoking rates than average, so the Tobacco Prevention and Control Program (TPCP) partners with Medicaid to offer quitting services to its clients. The program offers services through the Utah Tobacco Quit Line and includes coverage of tobacco cessation medications, as well as additional help for pregnant women. To learn more, contact TPCP at 1-877-220-3466.
Quitting Services for the Uninsured
Through a grant from the TPCP, participating Association for Utah Community Health (AUCH) community health centers offer Zyban and Chantix free of charge for their uninsured clients. To be eligible for these services, the client must be uninsured, a tobacco user, and an established client with a primary care provider at a participating community health center. If you are uninsured but do not currently go to a community health center for your primary care, you must become a client of the community health center for all of your primary care needs before you will be eligible to participate in this program. Contact your nearest community health center for more information.
African Americans & Smoking Cessation
Native Americans & Tobacco Use
Tobacco Use & Hispanics
LGBT Population & Smoking
As of January 2014, the Affordable Care Act (ACA) requires insurance plans to cover many clinical preventive services. Some of the covered preventive services include:
Click here for chart explaining 2014 Medicare Benefits on Tobacco Cessation Counseling
Medicare Part B covers both intermediate and intensive levels of tobacco cessation counseling for symptomatic and asymptomatic patients: intermediate and intensive.
Two cessation attempts are covered per year, and both coinsurance and deductibles are waived. Each attempt may include a maximum of four intermediate or intensive counseling sessions. The total annual benefit covers up to eight smoking cessation counseling sessions in a 12-month period. The patient may receive another eight counseling sessions during a second or subsequent year after 11 months have passed since the first Medicare-covered cessation counseling session.
To qualify for payment from Medicare, the following criteria must be met at the time of service:
Use the following CPT codes for patients who use tobacco and have been diagnosed with a recognized tobacco-related disease or exhibit symptoms consistent with tobacco-related disease:
|CODE||Type of Counseling||Description|
|99406||Intermediate||Smoking and tobacco-use cessation counseling visit greater than three minutes but not more than 10 minutes.|
|99407||Intensive||Smoking and tobacco-use cessation counseling visit greater than 10 minutes.|
Use the following CPT codes for patients who use tobacco but do not have symptoms of tobacco-related disease:
|CODE||Type of Counseling||Description|
|G0436||Intermediate||Smoking and tobacco use cessation counseling visit greater than 3 minutes but not more than 10 minutes.|
|G0437||Intensive||Smoking and tobacco use cessation counseling visit greater than 10 minutes.|
Medicare Part D covers FDA-approved cessation drug therapies. However, over-the-counter therapies are typically excluded.
Many states offer some payment for individual tobacco cessation and treatment counseling for Medicaid patients. However, providers are encouraged to contact their state Medicaid office for coverage information in their specific state.
As of January 1, 2014, all state Medicaid programs are required to support all FDA-approved smoking cessation medications without requiring co-pays or other financial barriers.
PRIVATE / COMMERICAL INSURANCE CARRIERS
Private insurers are required to provide evidence-based tobacco cessation counseling and interventions to all adults and pregnant women. Private payer benefits are subject to specific plan policies. Providers need to check with insurance plans to determine what specific interventions are included and the extent to which they are covered.
|HCPCS/CPT CODE||TYPE OF COUNSELING||DESCRIPTION|
|99406||Intermediate||Smoking and tobacco-use cessation counseling visit greater than three minutes but not more than 10 minutes (Short Descriptor: Smoke/tobacco counseling 3-10).|
|99407||Intensive||Smoking and tobacco-use cessation counseling visit greater than 10 minutes (Short Descriptor: Smoke/tobacco counseling greater than 10).|
|S9075||Smoking Cessation Treatment|
|S9453||Smoking Cessation Classes (nonphysician provider, per session)|
|99381-99397||Preventive Medicine Services|
|99078||Physician Educational Services in Group Setting|
Various E/M services (associated with acute or chronic care) may be coded. When providing an E/M service, if greater than 50 percent of face-to-face time with patient is spent on counseling, time may be used as a basis for selection of level of service.
|ICD-9 DIAGNOSIS CODE||DESCRIPTION|
|649.0x||Tobacco-use disorder complicating pregnancy, childbirth or puerperium|
|989.84||Other substances, chiefly nonmedicinal as to source, tobacco*|
SELF-PAY PATIENTS AND UNINSURED PATIENTS
Resources for patients who do not have insurance coverage or who have limited coverage from their insurance carrier include the following:
Visit the following recources for the most effective training and Continuing Medical Education (CME) courses to build your knowledge on tobacco use cessation and secondhand smoke exposure.
American Academy of Pediatrics (AAP) Tobacco Training and CME Courses
PediaLink Course: Addressing Tobacco Use and Exposure
(click the ‘online courses’ option, and you will see it listed)
Available June 12, 2013 – June 12, 2016
AAP Credit = 1.00
AMA PRA Category 1 Credit(s)™ = 1.00
NAPNAP Credit = 1.00
Pharmacology Rx = 0.50
Webinars through the AAP Richmond Center
The AAP Richmond Center hosts an ongoing webinar series to educate clinicians on child health issues related to tobacco control. Click here to view past webinars. Note that all of these webinars are presented free of charge.
Tobacco Training and CME Courses From Other Organizations: