ICD-10 Code for Low-Dose CT of the Chest for Smoking History
The appropriate ICD-10 code for low-dose CT (LDCT) of the chest for smoking history is Z87.891 (Personal history of tobacco use/dependence).
Coding Rationale
- Z87.891 is the appropriate code to use when ordering a low-dose CT scan for lung cancer screening in patients with significant smoking history 1
- This code indicates a personal history of tobacco use, which is the primary risk factor that qualifies patients for lung cancer screening with LDCT 2
- When documenting the order, it's important to include both the smoking history details (pack-years) and the code to ensure proper reimbursement 1
Eligibility Criteria for LDCT Screening
The U.S. Preventative Services Task Force (USPSTF) recommends annual lung cancer screening with LDCT for the following individuals:
- Ages 55-80 years with ≥30 pack-year smoking history who currently smoke or have quit within the past 15 years 2, 1
- The 2021 USPSTF update expanded eligibility to include individuals aged 50-80 years with ≥20 pack-year smoking history who currently smoke or have quit within the past 15 years 1
Technical Specifications for LDCT
- Screening should use a low-dose CT multidetector scanner with parameters that limit radiation exposure 1
- Typical parameters include: 120-140 kVp, 20-60 mAs, average effective dose of 1.5 mSv or less 1
- The technique should keep radiation dose as low as reasonably achievable while maintaining diagnostic quality 2
Documentation Requirements
When ordering LDCT for lung cancer screening, documentation should include:
- Patient's age 1
- Smoking history in pack-years (number of packs per day multiplied by years smoked) 1
- Current smoking status or years since quitting 1
- Absence of symptoms suggestive of lung cancer (as symptomatic patients require diagnostic imaging, not screening) 1
Coding Pitfalls to Avoid
- Do not use symptom-based codes (such as cough, shortness of breath) for screening examinations in asymptomatic individuals 1
- Do not use family history codes (Z80.1 - Family history of malignant neoplasm of trachea, bronchus and lung) as the primary code for LDCT screening based on smoking history 1
- Avoid using the code for screening for malignant neoplasms of the respiratory organs (Z12.2) without also including the smoking history code Z87.891 1
Special Considerations
- For patients with both smoking history and other risk factors (such as occupational exposures), include additional appropriate Z codes 1
- For patients undergoing follow-up LDCT for previously detected nodules, different coding may be required based on the specific findings 2, 3
- Adherence to follow-up screening is higher in former smokers than current smokers (50.0% vs 36.2%), which may impact coding patterns in practice 3