Screening for Lung Cancer with Low Dose CT and MLN MM9246


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I just recently watched an AAPC webinar from 4/20/16 and it discussed Lung cancer screening with Low Dose CT. I am a bit confused as one of the criteria is to always use Z87.891 (personal history of tobacco use/nicotine) but looks as though the screening can be done if patient is a current smoker. With coding guidelines if they are a current smoker you can't code Z87.891 (history of-these codes are used for .

Categories of Z Codes

4) History (of)

There are two types of history Z codes, personal and family. Personal history codes explain a patient's past medical condition that no longer exists

criteria for LDCT from MLN are

Medicare beneficiaries must meet all of the following criteria:
 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; and,
 Receive a written order for lung cancer screening with LDCT that meets the requirements
described in the NCD.
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
 A statement that the beneficiary is asymptomatic (no signs or symptoms of lung cancer);
 The National Provider Identifier (NPI) of the ordering practitioner.

In addition to the HCPCS code, these services must be billed with ICD-10 diagnosis code
Z87.891 (personal history of tobacco use/personal history of nicotine dependence), ICD-9
diagnosis code V15.82.

So if they are a current smoker how can we justify using Z87.891?

Thank you for any clarification that can be provided on this.