Written by William ‘Brad’ Howard, CPC, CMPA, CHONC, CIRCC
Eligible Patient Populations
Patients aged 50-77 years (For Medicare, commercial plans may accept 50-80)
Asymptomatic for lung cancer
Current Smokers or Former Smokers who have quit within the last 15 years
At least 20 pack-years smoking history
Pack-years = (packs smoked per day) × (years as a smoker); 1 pack =20 cigarettes
Patients aged 50-77 years (For Medicare, commercial plans may accept 50-80)
Asymptomatic for lung cancer
Current Smokers or Former Smokers who have quit within the last 15 years
At least 20 pack-years smoking history
Pack-years = (packs smoked per day) × (years as a smoker); 1 pack =20 cigarettes
Patients aged 50-77 years (For Medicare, commercial plans may accept 50-80)
Asymptomatic for lung cancer
Current Smokers or Former Smokers who have quit within the last 15 years
At least 20 pack-years smoking history
Pack-years = (packs smoked per day) × (years as a smoker); 1 pack =20 cigarettes
Counseling Visit
Prior to lung cancer screening via LDCT, a face-to-face counseling visit with the patient must occur
Screening must be ordered and documented by a licensed practitioner (physician, PA, NP)
Screening visits can be provided by auxiliary personnel, incident-to the licensed practitioner’s initial treatment plan
Can be performed in-office or via telehealth
Can be performed with a separately identifiable E/M visit (e.g., Annual Wellness Visit)
Can be performed more than once a year
Documentation in the medical record to support counseling visit should include the following:
Counseling on the following topics:
Importance of adhering to annual LDCT screenings
Ability and willingness to undergo potential treatment for a confirmed diagnosis
Impact of any comorbidities
Smoking cessation interventions and services (for active smokers)
Smoking cessation is billable during the same encounter as a separately identifiable E/M visit
Time specific to cessation counseling should be documented
Shared decision-making using one or more interactive decision aids
Shared decision-making describes a two-way discussion between the provider and patient on available options for screenings, risks and expected outcomes, as well as patient preferences and values
Decision aids describe educational literature, handouts, videos, or web-based tools that outline the potential benefits, risks, and uncertainties of LDCT screenings
Patient decision on whether to proceed with screening
Treatment plan for screening if ordered
Order for LDCT screening can be written or entered electronically
Prior to lung cancer screening via LDCT, a face-to-face counseling visit with the patient must occur
Screening must be ordered and documented by a licensed practitioner (physician, PA, NP)
Screening visits can be provided by auxiliary personnel, incident-to the licensed practitioner’s initial treatment plan
Can be performed in-office or via telehealth
Can be performed with a separately identifiable E/M visit (e.g., Annual Wellness Visit)
Can be performed more than once a year
Documentation in the medical record to support counseling visit should include the following:
Counseling on the following topics:
Importance of adhering to annual LDCT screenings
Ability and willingness to undergo potential treatment for a confirmed diagnosis
Impact of any comorbidities
Smoking cessation interventions and services (for active smokers)
Smoking cessation is billable during the same encounter as a separately identifiable E/M visit
Time specific to cessation counseling should be documented
Shared decision-making using one or more interactive decision aids
Shared decision-making describes a two-way discussion between the provider and patient on available options for screenings, risks and expected outcomes, as well as patient preferences and values
Decision aids describe educational literature, handouts, videos, or web-based tools that outline the potential benefits, risks, and uncertainties of LDCT screenings
Patient decision on whether to proceed with screening
Treatment plan for screening if ordered
Order for LDCT screening can be written or entered electronically
Prior to lung cancer screening via LDCT, a face-to-face counseling visit with the patient must occur
Screening must be ordered and documented by a licensed practitioner (physician, PA, NP)
Screening visits can be provided by auxiliary personnel, incident-to the licensed practitioner’s initial treatment plan
Can be performed in-office or via telehealth
Can be performed with a separately identifiable E/M visit (e.g., Annual Wellness Visit)
Can be performed more than once a year
Documentation in the medical record to support counseling visit should include the following:
Counseling on the following topics:
Importance of adhering to annual LDCT screenings
Ability and willingness to undergo potential treatment for a confirmed diagnosis
Impact of any comorbidities
Smoking cessation interventions and services (for active smokers)
Smoking cessation is billable during the same encounter as a separately identifiable E/M visit
Time specific to cessation counseling should be documented
Shared decision-making using one or more interactive decision aids
Shared decision-making describes a two-way discussion between the provider and patient on available options for screenings, risks and expected outcomes, as well as patient preferences and values
Decision aids describe educational literature, handouts, videos, or web-based tools that outline the potential benefits, risks, and uncertainties of LDCT screenings
Patient decision on whether to proceed with screening
Treatment plan for screening if ordered
Order for LDCT screening can be written or entered electronically
Billing
Pre-authorization is not required for traditional Medicare patients
Pre-authorization may or may not be required for Medicare Advantage, Medicaid, and commercial plans
Shared decision-making visit can be reported using HCPCS code G0296 (Counseling visit to discuss need for lung cancer screening using LDCT)
Append modifier -95 if performed via telehealth
Append modifier -25 to any separately identifiable E/M visit on same date-of-service
No patient copay
LDCT screening can be reported using:
CPT code 71271 (Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)
No patient copay
Recommended ICD-10 diagnosis codes for G0296 and 71271 (depending on documentation of smoking status):
Z87.891 (Personal history of nicotine dependence)
F17.210 (Nicotine dependence, cigarettes, uncomplicated)
F17.211 (Nicotine dependence, cigarettes, in remission)
F17.213 (Nicotine dependence, cigarettes, with withdrawal)
F17.218 (Nicotine dependence, cigarettes, with other nicotine-induced disorders)
F17.219 (Nicotine dependence, cigarettes, with unspecified nicotine-induced disorders)
Smoking cessation counseling for active smokers can be reported using:
99406 (4-10 minutes of counseling)
99407 (More than 10 minutes of counseling)
Append modifier -95 if performed via telehealth
Diagnosis code F17.210 (Nicotine dependence, cigarettes, uncomplicated)
Append modifier -25 to any separately identifiable E/M visit on same date-of-service
Pre-authorization is not required for traditional Medicare patients
Pre-authorization may or may not be required for Medicare Advantage, Medicaid, and commercial plans
Shared decision-making visit can be reported using HCPCS code G0296 (Counseling visit to discuss need for lung cancer screening using LDCT)
Append modifier -95 if performed via telehealth
Append modifier -25 to any separately identifiable E/M visit on same date-of-service
No patient copay
LDCT screening can be reported using:
CPT code 71271 (Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)
No patient copay
Recommended ICD-10 diagnosis codes for G0296 and 71271 (depending on documentation of smoking status):
Z87.891 (Personal history of nicotine dependence)
F17.210 (Nicotine dependence, cigarettes, uncomplicated)
F17.211 (Nicotine dependence, cigarettes, in remission)
F17.213 (Nicotine dependence, cigarettes, with withdrawal)
F17.218 (Nicotine dependence, cigarettes, with other nicotine-induced disorders)
F17.219 (Nicotine dependence, cigarettes, with unspecified nicotine-induced disorders)
Smoking cessation counseling for active smokers can be reported using:
99406 (4-10 minutes of counseling)
99407 (More than 10 minutes of counseling)
Append modifier -95 if performed via telehealth
Diagnosis code F17.210 (Nicotine dependence, cigarettes, uncomplicated)
Append modifier -25 to any separately identifiable E/M visit on same date-of-service
Pre-authorization is not required for traditional Medicare patients
Pre-authorization may or may not be required for Medicare Advantage, Medicaid, and commercial plans
Shared decision-making visit can be reported using HCPCS code G0296 (Counseling visit to discuss need for lung cancer screening using LDCT)
Append modifier -95 if performed via telehealth
Append modifier -25 to any separately identifiable E/M visit on same date-of-service
No patient copay
LDCT screening can be reported using:
CPT code 71271 (Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)
No patient copay
Recommended ICD-10 diagnosis codes for G0296 and 71271 (depending on documentation of smoking status):
Z87.891 (Personal history of nicotine dependence)
F17.210 (Nicotine dependence, cigarettes, uncomplicated)
F17.211 (Nicotine dependence, cigarettes, in remission)
F17.213 (Nicotine dependence, cigarettes, with withdrawal)
F17.218 (Nicotine dependence, cigarettes, with other nicotine-induced disorders)
F17.219 (Nicotine dependence, cigarettes, with unspecified nicotine-induced disorders)
Smoking cessation counseling for active smokers can be reported using:
99406 (4-10 minutes of counseling)
99407 (More than 10 minutes of counseling)
Append modifier -95 if performed via telehealth
Diagnosis code F17.210 (Nicotine dependence, cigarettes, uncomplicated)
Append modifier -25 to any separately identifiable E/M visit on same date-of-service
Abnormal Findings From LDCT Screening
Interval chest CT or CTA may be required following abnormal LDCT screening results
This is a diagnostic study performed off-cycle from annual LDCT screenings
Co-pay may be required
Report CT using 71250 (Computed tomography, diagnostic; without contrast material)
Report CTA using 71275 (Computed tomography angiography, chest (non-coronary), with contrast material(s), including noncontrast images, if performed, and image postprocessing)
If lung cancer diagnosis is confirmed patient should be removed from future lung cancer screenings
Patient may be re-admitted to LDCT screening treatment plan following completed treatment of lung cancer
Interval chest CT or CTA may be required following abnormal LDCT screening results
This is a diagnostic study performed off-cycle from annual LDCT screenings
Co-pay may be required
Report CT using 71250 (Computed tomography, diagnostic; without contrast material)
Report CTA using 71275 (Computed tomography angiography, chest (non-coronary), with contrast material(s), including noncontrast images, if performed, and image postprocessing)
If lung cancer diagnosis is confirmed patient should be removed from future lung cancer screenings
Patient may be re-admitted to LDCT screening treatment plan following completed treatment of lung cancer
Interval chest CT or CTA may be required following abnormal LDCT screening results
This is a diagnostic study performed off-cycle from annual LDCT screenings
Co-pay may be required
Report CT using 71250 (Computed tomography, diagnostic; without contrast material)
Report CTA using 71275 (Computed tomography angiography, chest (non-coronary), with contrast material(s), including noncontrast images, if performed, and image postprocessing)
If lung cancer diagnosis is confirmed patient should be removed from future lung cancer screenings
Patient may be re-admitted to LDCT screening treatment plan following completed treatment of lung cancer
FAQs
Can the shared decision-making visit (G0296) occur on the same day as the lung cancer screening CT (71271)?
Can the shared decision-making visit (G0296) occur on the same day as the lung cancer screening CT (71271)?
Can the shared decision-making visit (G0296) occur on the same day as the lung cancer screening CT (71271)?
Can the shared decision-making visit (G0296) occur on the same day as the lung cancer screening CT (71271)?
Do different Lung-RADS categories affect coding of subsequent scans?
Do different Lung-RADS categories affect coding of subsequent scans?
Do different Lung-RADS categories affect coding of subsequent scans?
Do different Lung-RADS categories affect coding of subsequent scans?