Revised Billing Guidance Expands Acceptable ICD-10 Coverage for CT Lung Screening

ADVOCATE has learned that the Centers for Medicare and Medicaid Services (CMS) will soon be releasing the revised billing guidance that expands the ICD-10 codes that are acceptable for billing for the low-dose CT lung cancer screening benefit for individuals who smoke or have a history of smoking.

As you may recall, CMS announced in February of 2015 that Medicare would pay for a low-dose CT lung cancer screening for certain patients who had a history of smoking.

The coverage was technically effective on February 5, 2015; however, CMS did not simultaneously announce billing instructions or guidance for this new benefit and asked providers to hold claims until the proper guidance could be developed.

In late 2015, after much prompting from the Healthcare Billing Management Association (HBMA) and others, CMS announced the new payment policy and issued guidance on what diagnosis codes would be required to pay for the low-dose CT lung cancer screening benefit.

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Unfortunately, CMS neglected to include the ICD-10 for “currently smoking” (F17.2) to the list of appropriate ICD-10 diagnosis codes. CMS acknowledged the error and will issue a correction “at our next earliest opportunity.”

CMS has informed HBMA that they will be releasing contractor instructions adding the “currently smoking” ICD-10 code (F17.2) to the list of approved codes for low-dose CT lung cancer screening. Unfortunately, because of the approval process for adding this code, it will not take effect until July 5, 2016.

As always, ADVOCATE will keep you up to date on this and all issues impacting radiology as they become available.

Best regards,
Kirk Reinitz, CPA
President/CEO