Radiology Coding Alert

Question: Several Medicare patients have come in for low-dose computed tomography (LDCT) lung cancer screening scans. I’m new to radiology coding, and I’m not sure what CPT^® codes to report.

What codes should I assign to report an LDCT scan?

New Mexico Subscriber

Answer: Medicare covers annual lung cancer screenings via a LDCT scan for those patients who meet certain criteria. According to the Billing and Coding Article A58641 on the Medicare Coverage Database, you’ll need two codes to report LDCT services for Medicare beneficiaries:

• G0296 (Counseling visit to discuss need for lung cancer screening (ldct) using low dose ct scan (service is for eligibility determination and shared decision making))
• 71271 (Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s))

Prior to the actual procedure, the provider will discuss the LDCT scan and the patient’s need for it. You’ll report this counseling visit with G0296. The counseling visit needs to take place before the initial scan in the first year, and the patient will need a written order from a physician or nonphysician practitioner (NPP) in subsequent years. You’ll then assign 71271 to report the LDCT scan after it takes place.

Several criteria need to be met for the Medicare beneficiary to be eligible for the LDCT scan. According to National Coverage Determination (NCD) 210.14, the beneficiary must:

• Be age 50-77 years old;
• Show no signs or symptoms of lung cancer;
• Have a tobacco smoking history of at least 20 pack-years;
• Be a current smoker or have quit within the last 15 years; and
• Receive an LDCT lung cancer screening order.

In February 2022, the NCD lowered the minimum age from 55 to 50 years old, as well as the pack-years from 30 to 20. Pack-years is a number that explains a patient’s extended smoking habit, and the number is determined by multiplying the daily pack consumption by the duration in years.

You’ll also need to show the medical necessity for the scan with appropriate ICD-10-CM codes. Ensure your report is solid by assigning any applicable diagnosis codes, including:

• Z87.891 (Personal history of nicotine dependence)
• F17.211 (Nicotine dependence, cigarettes, in remission)
• F17.213 (… with withdrawal)
• F17.218 (… with other nicotine-induced disorders)
• F17.219 (… with unspecified nicotine-induced disorders)

Providers perform a LDCT screening for lung cancer when the patient isn’t exhibiting symptoms of the disease but are at high risk. If a physician feels the patient could be at risk of developing cancer, they’ll order the LDCT screening to evaluate the patient for the disease early.