For Providers
This page has everything you need to know about determining patient eligibility, calculating pack-year smoking history, and ordering LungCheck.
Be sure to contact us if you have any questions.
Why Lung Screening (LungCheck)?
Lung screening should be part of your patients’ annual physical exam.
The National Committee for Quality Assurance (NCQA) is developing a Healthcare Effectiveness Data and Information Set (HEDIS) quality measure for lung cancer screening (expected as soon as late 2024).
Lung screening can be easily incorporated into your practice routine.
Early detection is key. Early-stage lung cancer is treatable and may be curable with surgery alone.
Two large randomized controlled trials show benefits of lung cancer screening: NLST and NELSON Trial
Who is Eligible for LungCheck?
50-80-year-olds (50-77-year-olds with Medicare & Medicaid)
≥20 pack-years cumulative smoking history –
Pack-Year calculatorCurrently smoke or quit smoking ≤15 years ago
Pack-Year Calculator
It can be challenging to accurately estimate a patient’s pack-year history. Many patients smoke intermittently, or have quit and resumed several times. They might also vary the number of packs they smoke during each of these periods.
Use the calculator below to determine your patient’s total pack-years.
(1 pack = 20 cigarettes)
Template for Chart Documentation
This template contains the required documentation for insurance approval. You may copy and paste it into a patient note.
Age: *** (USPSTF 50-80, CMS 50-77)
Smoking Status: current/former/never (Current, Former)
If former, quit time: *** years (<15 years)
Pack Years: *** (>20 pack years)
Apparent signs or symptoms of lung cancer: Y/N (No)
Patient meets USPSTF/CMS guidelines for lung cancer LDCT screening: Y/N (Yes)
Discussed the aim of LDCT screening is to detect lung cancer at an early stage when it is most treatable. Discussed the follow-up diagnostic process, impact of comorbidities. Patient is willing to undergo diagnosis and treatment.
Discussed the benefits of screening: NLST demonstrated 20% reduction in lung cancer mortality using LDCT vs Chest x-ray. Patient acknowledges importance of annual screening to achieve these results.
Discussed the harms of screening: radiation exposure, false positives, over-diagnosis, anxiety.
Counseled patient on importance of smoking cessation (or maintaining smoking abstinence). Assessed readiness to quit. Patient is/is not ready to quit. Made referral to Tobacco Treatment Program/Quitline.
Shared decision making completed as above. Ordered Low-Dose CT Lung Screening.
How to order LungCheck
Using a CPT code other than the ones listed in Step 1, or not including one of the diagnosis codes listed in Step 2, will lead to claim denial by Medicare.
Screening is only for asymptomatic patients.
Screening
Baseline and Annual CT Exams
Step 1: Select the following test:
CPT 71271 (CT, thorax, low-dose for cancer screening without contrast)
Step 2: Select the most applicable nicotine dependence ICD-10 diagnosis code(s) from the options below:
Z87.891 for former smokers (personal history of nicotine dependence)
F17.21 for current smokers (nicotine dependence)
F17.210 Nicotine dependence, cigarettes, uncomplicated (most commonly used and accepted)
Step 3 (Optional): Select the applicable code(s) for shared decision making and smoking cessation counseling
CPT G0296: In-person or telehealth visit to discuss need for lung cancer screening (LCS) using low-dose CT (LDCT) (eligibility determination and shared decision making)
CPT 99406: Smoking & tobacco use cessation counseling visit; intermediate, >3 minutes and ≤10 minutes
CPT 99407: Smoking & tobacco use cessation counseling visit; intensive, >10 min
Diagnostic
Follow-Up CT Exams
Your patient has recently undergone a Baseline or Annual CT screening exam. The radiologist needs a follow-up CT exam to make a diagnosis (the radiology report mentions Lung-RADS 0, 3, or 4.)
Step 1: Select the following test
CPT 71250 (Computed tomography, thorax, diagnostic; without contrast material)
Step 2: Select the following ICD-10 diagnosis code
R91.8 (Abnormal finding on lung imaging)
Step 3 (Optional): Select the applicable code(s) for shared decision making and smoking cessation counseling
CPT 99406: Smoking & tobacco use cessation counseling visit; intermediate, >3 minutes and ≤ 10 minutes
CPT 99407: Smoking & tobacco use cessation counseling visit; intensive, > 10 min
How to Order Guides
Lung-RADS Interpretation & Management
Lung-RADS® is a lexicon and atlas created by the American College of Radiology (ACR) to standardize lung screening reporting and management recommendations. Radiologists will assign a Lung-RADS score (0, 1, 2, 3, or 4) to your patient’s exam based on the most suspicious nodule.
| Lung-RADS | Interpretation | Managment |
|---|---|---|
| 0 | Prior exams are pending: If your patient has prior imaging exams that need to be uploaded for comparison, Lung-RADS 0 is assigned temporarily. | Provide prior exam(s) to radiology center. The radiologist will compare the exams, make an addendum, and assign a new Lung-RADS score. |
| The lungs cannot be completely evaluated: If all or part of your patient’s lungs cannot be evaluated (e.g., patient was breathing and lungs are blurry), Lung-RADS 0 is assigned temporarily. | Patient returns to radiology center for more images as soon as possible. Radiologist assigns a new Lung-RADS score after the patient is re-imaged. | |
| Suspected Infectious or Inflammatory Findings: If your patient has lung findings that the radiologist thinks are more likely infectious or inflammatory than lung cancer, Lung-RADS 0 is assigned. | The patient should get a follow-up chest CT (CPT 71250) in 1-3 months. A new Lung-RADS score will be assigned on follow-up exam. | |
| 1 | Patient has no or definitely benign nodules (calcified granulomas or hamartomas). | Schedule patient for 12-month annual lung screening exam |
| 2 | Patient has nodules that are small or stable, suggestive of benignity. | |
| 3 | Patient has nodules that are probably benign but need shorter interval follow-up because they are of a certain size, new, or growing. | Schedule patient for 6-month follow-up chest CT scan (CPT 71250) |
| 4A | Patient has nodules that are suspicious because they are of a certain size, density, new, growing, or in an airway. | Schedule patient for 3-month follow-up chest CT scan (CPT 71250) or PET/CT; The radiologist should make a specific recommendation |
| 4B | Patient has nodules that are very suspicious because they are of a certain size, density, new, growing, or in an airway. There are multiple potential management options for these nodules. The radiologist should make a specific recommendation; if not, it is appropriate to ask the radiologist what they think is the most appropriate next step. | Potential management options are: 1)Diagnostic chest CT with or without contrast; 2) PET/CT; 3) tissue sampling; and/or 4) referral for further clinical evaluation. Management depends on clinical evaluation, patient preference, and the probability of malignancy |
| 4X | Patient has nodules that meet criteria for Lung-RADS 3, 4A, or 4B but have additional imaging findings that increase suspicion of lung cancer (e.g., slow growth over multiple scan, lymphadenopathy). The radiologist should make a specific recommendation; if not, it is appropriate to ask the radiologist what they think is the most appropriate next step. | |
| S | S modifier may be added to Lung-RADS categories 0-4 when patient has potentially clinically significant finding(s) unrelated to lung cancer. Management should adhere to available ACR Incidental Findings management recommendations: https://www.acr.org/Clinical-Resources/Incidental-Findings The ACR Lung Cancer Screening CT Incidental Findings Quick Reference Guide summarizes common findings and management - View PDF | Management should be specified by the radiologist |
Explaining results to your patient
Your results will fall into one of these categories: negative, positive, or incomplete.
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Lung nodules are common. If your patient has no lung nodules, or nodules that look benign, then their exam is considered negative. Order their next LungCheck screening in 12 months.
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The radiologist needs more information about a nodule. The report will specify when the patient should return for a repeat scan to see if the nodule has changed or grown (usually in 3 or 6 months). Depending on the results of this follow-up scan, the patient will need another scan in 6 or 12 months.
Very rarely, the radiologist will recommend a lung biopsy.
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The radiologist needs more images to make a diagnosis or recommendation. One common example is identifying pneumonia on LungCheck. The patient will be asked to repeat the scan in 1-3 months to see if the infection has resolved.
Common Patient Reactions
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LungCheck is for people who don’t have symptoms. When lung cancers are small, they typically don’t cause symptoms. By the time cancers grow and cause pain or shortness of breath, they’re harder to treat and cure. We do a LungCheck when you’re feeling well in order to catch lung cancers early.
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A patient navigator can help you call and schedule a LungCheck for a time that is convenient for you.
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It’s normal to be afraid. In most cases, your LungCheck will be normal and can give you peace of mind. In the rare event that you need a biopsy, this can help you get the diagnosis and treatment you need. We can help you do this.
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Even if you don’t smoke much, LungCheck might be right for you. We can work together to calculate your pack-year smoking history to see if you qualify.
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Congratulations! Quitting smoking was one of the best things you’ve done for your health. If you quit within the past 15 years, a LungCheck is the next step to helping you live a longer, healthier life.
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LungCheck is usually covered by insurance. We can work with you to identify if a copay is required.
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A lung biopsy is a short procedure that involves taking a sample of your lung tissue. To reach the lung, a doctor will insert a needle through the chest wall, or insert a camera through the mouth. Your doctor may give you some medications to make you more comfortable. The doctor who performs the biopsy will explain the procedure in much more detail, and answer any questions you might have.
How LungCheck Navigators Can Help You
LungCheck navigators are liaisons for patients and healthcare providers. They keep LungCheck front-of-mind and can assist both you and your patients at each step of the LungCheck process.
01. Determine Insurance & Eligibility
Direct you to resources for collecting smoking history, calculating pack-years, and ordering LungCheck with the correct CPT and ICD codes.
Provide templates for the documentation necessary for insurance approval.
Review patient insurance to determine eligibility.
02. Shared Decision Making - Provide Templates and Patient Education
Provide templates for documentation on shared decision making and smoking cessation counseling.
Know CPT and ICD codes for shared decision making and smoking cessation counseling.
Provide resources for smoking cessation.
03. Making The LungCheck Happen
Help patients schedule their appointments.
Send appointment reminders.
Help facilitate transportation.
Verify the imaging center received the written order.
04. Follow-up
Communicate results to patients and offer to reconnect patients to you.
Help you order the correct follow-up exams.
Help guide patients on next steps if necessary.
Smoking Cessation & Tobacco Treatment Resources
Online - Smokefree.gov
Many people who smoke don’t know where to begin their quit journeys. There isn’t one right way to start, but getting prepared and knowing what to expect can make things easier.
Text - Smokefree.gov
Smokefree.gov offers free text messaging programs that give 24/7 encouragement, advice, and tips for becoming smokefree and being healthier.
Text QUIT to 47848
Talk - NYC Smoke-Free
Whether you want help to quit or have questions about our services, we're here to help. To talk with a Quit Coach:
Benefits of Lung Cancer Screening
Case Studies
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Ronald is a 51-year-old accountant with hypertension and hyperlipidemia, both of which are well-managed on oral medications. During his annual physical exam, he mentioned “I started smoking in college, but quit a decade ago.” Ronald’s primary care physician calculated that he had a 23 pack-year smoking history and recommended LungCheck. Ronald was unsure whether he had time to get a LungCheck, but the office staff helped him schedule a scan at a convenient time. Ronald’s first LungCheck was negative. Ronald continued to follow up for annual LungCheck screenings. His third LungCheck was positive for a suspicious nodule, which was biopsied and was positive for adenocarcinoma. Ronald underwent curative surgery and recovered without complications. Four years after surgery, Ronald walked his daughter down the aisle on her wedding day.
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Lori is a 68-year-old retired schoolteacher with hyperlipidemia, gout, and GERD. She has smoked 1 pack of cigarettes per day for 31 years. Lori’s primary care physician recommends that she get a LungCheck, given her 31 pack-year smoking history. Lori agrees. Her LungCheck was negative for nodules but was notable for emphysema. Coronary calcium was also incidentally identified. Lori’s primary care physician referred her to a pulmonologist and a cardiologist for further evaluation. They were able to work with Lori to help her manage her emphysema and decrease her risk of MI by adopting a plant-based diet and starting medications to treat hyperlipidemia. After these interventions, Lori was motivated to quit smoking. Two years later, Lori says “I have a new lease on life!” She is able to enjoy longer walks with her partner and dog.
Contraindications to Referral ⏵
LungCheck is for asymptomatic patients. Patients who have symptoms of lung cancer should receive a diagnostic CT instead of a low-dose CT (CPT 71250: Computed tomography, thorax, diagnostic; without contrast material).
LungCheck is for patients who would benefit from screening. Patients who are not candidates for curative surgery should not undergo LungCheck screening.
Patients who are not high-risk for lung cancer should not be screened.