Outpatient Facility Coding Alert

Question: I’m looking for some authoritative guidelines pertaining to the proper reporting of G0297 (Low dose CT scan (LDCT) for lung cancer screening). Does the referring provider have to definitively attest to the cessation of smoking shared visit/counseling service? If so, does that need to be included along with the order?

New Mexico Subscriber

Answer: Medicare covers this question in the Medicare Learning Network (MLN) Matters article “Medicare Coverage of Screening for Lung Cancer with Low Dose Computed Tomography (LDCT).”

Under “Counseling and Shared Decision-Making Visit,” CMS states the following:

• “Before the first lung cancer LDCT screening occurs, the beneficiary must receive a written order for LDCT lung cancer screening during a lung cancer screening counseling and shared decision-making visit that includes the following elements and is appropriately documented in the beneficiary’s medical records.”

CMS goes on to list a number of requirements the referring provider must meet in order for the counseling session to meet the necessary criteria. However, nowhere in the guidelines does CMS state that the provider must “attest” that the visit met all the appropriate criteria. Rather, CMS instructs the referring physician to appropriately document each of the necessary criteria in the patient’s medical record.

Ideally, these records should be accessible to both parties — as the imaging facility should not perform the LDCT scan until they confirm all the appropriate counseling measures were taken by the referring provider.

Remember: These guidelines only apply to a patient’s initial LDCT scan. CMS states that “written orders for subsequent annual LDCT screens may be furnished during any appropriate visit with a physician or qualified nonphysician practitioner (PA, NP, or CNS).”

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