Low-Dose CT Scan for Lung Cancer Screening: Clinical and Coding Considerations.
Lung cancer screening with low-dose CT (LDCT) scan was shown to reduce lung cancer mortality in the National Lung Screening Trial, a large randomized controlled trial of high-risk current and former smokers. Despite ongoing uncertainty over the effectiveness of LDCT scan in the real-world setting, the Centers for Medicare and Medicaid Services (CMS) decided to cover LDCT scan as a preventive service. As part of its National Coverage Determination, CMS set forth a series of requirements for reimbursement of LDCT scan, including a counseling and shared decision-making visit prior to a LDCT scan being ordered. During this visit, providers must determine patient eligibility, engage in shared decision-making around LDCT scan, discuss the importance of adherence to screening, and provide smoking cessation counseling (if applicable). Two new billing codes were introduced for the counseling and shared decision-making visit and subsequent LDCT scan. In this review, we summarize the evidence around lung cancer screening and describe practical aspects of the counseling and shared decision-making, including billing considerations. We conclude with a discussion of the greater implications of CMS National Coverage Determination, especially as it pertains to quality assurance around new screening tests.
Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA.
Yiwey
Y
Shieh
Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. Electronic address: martin.bohnenkamp@uphs.upenn.edu.
Martin
M
Bohnenkamp
D003376:Counseling / Q000458:organization & administration*; D003657:Decision Making; D055088:Early Detection of Cancer / Q000379:methods / Q000592:standards; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis*; D011785:Quality Assurance, Health Care; D011829:Radiation Dosage; D014057:Tomography, X-Ray Computed / Q000379:methods*
LDCT scan; lung cancer screening; shared decision-making