Smoking Cessation

CODING (Giving pamphlets counts)

  • Problem list

    • Z71.6 Tobacco Abuse Counseling

  • NEW ORDER ENTRY

    • 99406 Tobacco Use Cessation Intermediate (3-10 Minutes)

    • 99407 Tobacco Use Cessation Intensive (> 10 minutes)

  • Importance: These metrics are being tracked at command level. In Civilian these metrics are also tracked and can play important role in reimbursement. This aside from just the importance we have as primary care physicians in doing right by our patients.


Resources we can provide patients regarding smoking cessation:

National Toll Free number for Behavioral intervention resources (Counseling support): 1-800-QUIT-NOW

Naval Hospital Camp Pendleton Smoking Cessation Program: https://camp-pendleton.tricare.mil/Health-Services/Preventive-Care/Health-Promotions-and-Wellness/Tobacco-Cessation

Wellness Coaching through Military OnceSource: https://www.militaryonesource.mil/confidential-help/specialty-consultations/health-wellness-coaching/


Guidelines:

For non-pregnant patients wishing to quit:

  • NRT (Gum vs Transdermal) (OTC available) (Can use combination of two NRT products (ex: patch + short acting gum/lozenge) and combination has been shown to be superior)

  • Generic Varenicline (NOT CHANTIX, see below) (UpTODate: "Most patients: Trial of Varenicline OR combination of 2 NRT products)

  • Alternative: Buproprion SR (Zyban): FDA approved to help people quit smoking. (Rx required)

  • CBT with Psychology

  • Cessation Program


For pregnant patients wishing to quit

  • NRT (Gum vs Transdermal)

  • Alternative: Buproprion SR (Zyban): FDA approved to help people quit smoking. (Pregnancy safety data for NRT more robust compared to Buproprion, so start with NRT)

  • DO NOT use Varenicline in pregnant individuals b/c lack of safety info.

  • CBT with Psychology

  • Cessation Program

  • Discussion with pt: Maximal benefit if cessation in 1st trimester though quitting anytime has beneficial effects. MORE likely to be successful if incouraged to quit rather than cut down. Provide ongoing support after delivery as nearly 50% of quitters will relapse within the first two months after delivery.


In Sept. 16, 2021, Chantix (Brand Name) Was recalled due to contamination w/ potential carcinogen. Since then it has been FULLY DISCONTINUED. HOWEVER there are FDA approved generic versions (Varenicline) available.


*This Update based on readings from UpToDate by Brad Matheus 1/4/2023. Anticipate will need to be updated overtime.