Q: What ICD-10 code is required by CMS for the LDCT Lung Cancer Screening?
A: Initially, the CMS National Coverage Determination (NCD) 210.14 allowed only one ICD-10 code, Z87.891 – Personal history of nicotine dependence. However NCD 210.14 lists two smoking criteria that would allow the screening to be paid. They are:

  • Tobacco smoking history of at least 30 pack-years (one pack-year = smoking one pack per day for one year; 1 pack = 20 cigarettes);
  • Current smoker or one who has quit smoking within the last 15 years¹

ICD-10 is clear that Z87.891 cannot be used for a person who is a current cigarette smoker.  Responding to a request from the American College of Radiology and others, CMS in Change Request (CR) 9540 has added the following ICD-10 codes to LDCT procedures after October 1, 2015.

This will allow for appropriate coding of a current smoker.

  • F17.210 Nicotine dependence, cigarettes, uncomplicated
  • F17.211 Nicotine dependence, cigarettes, in remission
  • F17.213 Nicotine dependence, cigarettes, with withdrawal
  • F17.218 Nicotine dependence, cigarettes, with other nicotine-induced disorders
  • F17.219 Nicotine dependence, cigarettes, with unspecified nicotine-induced disorders²

The effective date of the CR is 2/15/2015. ICD-9 code 305.1, Tobacco use disorder, assigned for current smokers on LDCT procedures prior to October 1, 2015.³

¹Medicare National Coverage Determinations Manual Chapter 1, Part 4 (Sections 200 – 310.1) Coverage Determinations 210.14
²Centers for Medicare & Medicaid Services Change Request 9540 Number 9540.8

Author - Male

About the author

Nicholas Parish of Compliance – Radiology, McKesson Business Performance Services.