Lung Cancer Screening using Low Dose CT Guidelines
Author: Barbara Wiggin, Manager Cardiology and Nuclear Medicine Services, MGMC
In 2014 MaineGeneral diagnosed and treated 1,118 patients with malignancies. Lung CA is our second highest CA with low detection at stages 0 and I when it is easy to treat and prognosis much better for our patients. The 5 yr survival rate at for Stage 1 = 60-80% and at stage III and IV is 10% or less. As we’ve seen with other cancers a strong screening process can make a difference
On August 21, 2015 CMS issued a National Coverage Determination (NCD 210.14) that provides for Medicare coverage of screening for lung cancer with LDCT. Effective January 4, 2016 Medicare contractors will accept claims with dates of service on and after February 5, 2015.
Most private insurance companies are following the same criteria or require prior authorization for the exam. If a patient has private insurance please check as each may have a different requirement.
For financial assistance please call 1-877-255-3680.
- Patient Eligibility
- Be 55–77 years of age
- Be asymptomatic (no signs or symptoms of lung cancer)
- Have a tobacco smoking history of at least 30 pack-years (one pack-year = smoking one pack per day for one year; 1 pack = 20 cigarettes)
- Be a current smoker or one who has quit smoking within the last 15 years
- Receive a written order for lung cancer screening with LDCT that meets the requirements described below (Provide appropriate ICD-10 code with the order—Z87.891, F17.210, F17.211, F17.213, F17.218, F17.219).
- Placing the Order
Written orders for lung cancer LDCT screenings must be appropriately documented in the beneficiary’s medical record, and must contain the following information:
- Date of birth
- Actual pack–year smoking history (number)
- Current smoking status, and for former smokers, the number of years since quitting smoking
- A statement that the beneficiary is asymptomatic (no signs or symptoms of lung cancer)
- The National Provider Identifier (NPI) of the ordering practitioner
- Counseling and Shared Decision-Making Visit (Highly recommend using CPT code G0296)
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. Shared decision making (SDM) is a collaborative process that allows patients and their providers to make health care decisions together, taking into account the best scientific evidence available, as well as the patient’s values and preferences.
The visit must be furnished by a physician or qualified non-physician practitioner. The following elements must be appropriately documented in the beneficiary’s medical record:
- Determination of beneficiary eligibility including age, absence of signs or symptoms of lung cancer, a specific calculation of cigarette smoking pack-years; and if a former smoker, the number of years since quitting
- Shared decision-making, including the use of one or more decision aids (see links below), to include benefits and harms of screening, follow-up diagnostic testing, over-diagnosis, false positive rate, and total radiation exposure
- Counseling on the importance of adherence to annual lung cancer LDCT screening, impact of co-morbidities, and ability or willingness to undergo diagnosis and treatment
- Counseling on the importance of maintaining cigarette smoking abstinence if former smoker; or the importance of smoking cessation if current smoker and, if appropriate, furnishing of information about tobacco cessation interventions
- If appropriate, the furnishing of a written order for lung cancer screening
- LDCT Lung Screening Reports and follow up
- All reports following the exam will include a LUNG RAD Category with a recommendation for follow up. This is required by CMS along with tracking of patients and their care through a specific Lung Screening Registry. The LUNG RADS are set up similar to breast screenings which include BI RADS.
- All results will be sent to the primary care provider. All results are also sent to our Lung Cancer Navigators. If a patient is positive the Lung Cancer RN Navigators ensure no one falls through the cracks and can help if and when follow up Cancer Care or treatment is needed.
- All positive cases are being reviewed by tumor board to ensure best practice and clinical outcomes.
- Coinsurance and Deductibles
Medicare coinsurance and Part B deductible are waived for this preventive service.
Each private insurance payer is different. Please have your patient check to see if their insurance is covering this under preventive care.
For financial assistance please call 1-877-255-3680.
CMS Medicare Learning Network MLN Matters Publication MM9246
National Coverage Determination Manual Chapter 1, Part 4, Section 210.14 – Lung Cancer Screening with Low Dose Computed Tomography (LDCT) located at cms.gov
American College of Radiology - http://www.acr.org/Quality-Safety/Resources/Lung-Imaging-Resources
Links to the Shared Decision Making Materials available from the American College of Radiology, the National Comprehensive Cancer Center and NIH- National Cancer Institute:
KRHA Guidelines and Standard Processes Disclaimer
To promote the provision of efficient and effective healthcare services, Kennebec Region Health Alliance helps develop and disseminates practice guidelines for use by its member practices. Such guidelines are based upon various sources that KRHA believes to be reliable, which may include but is not limited to, guidelines from widely recognized professional societies, boards and colleges such as the American Medical Association (AMA). Practice guidelines are reviewed at least every two years and updated as necessary to reflect changes in medical practice.
These practice guidelines are not meant to express standards of care and should not be regarded as evidence of such standards. These Guidelines describe criteria for general operating practice and procedure and are for voluntary use. Guidelines are not a substitute for a physician’s or healthcare professional’s independent judgment.
Information on this website should not be relied on as an alternative to medical advice from a physician or other healthcare professional. If there are specific questions on any medical matter, a physician or healthcare professional should be consulted.