How To Use HCPCS Code G0296

HCPCS code G0296 describes a counseling visit to discuss the need for lung cancer screening using a low dose CT scan (LDCT). This service is specifically for eligibility determination and shared decision making. In this article, we will explore the details of HCPCS code G0296, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS G0296?

HCPCS code G0296 is used to identify a counseling visit that focuses on discussing the need for lung cancer screening using a low dose CT scan. The purpose of this visit is to determine the patient’s eligibility for the screening and engage in shared decision making. It is important to note that this code is specifically for the counseling visit and not for the actual screening procedure itself.

2. Official Description

The official description of HCPCS code G0296 is “Counseling visit to discuss the need for lung cancer screening using low dose CT scan (LDCT) (service is for eligibility determination and shared decision making).” The short description is “Visit to determine LDCT eligibility.”

3. Procedure

1. The provider initiates the counseling visit to discuss the need for lung cancer screening using a low dose CT scan.
2. During the visit, the provider explains the purpose and benefits of the screening to the patient.
3. The provider assesses the patient’s risk factors for lung cancer and determines their eligibility for the screening.
4. Shared decision making takes place, where the provider and patient discuss the potential benefits, risks, and limitations of the screening.
5. Based on the discussion, the provider and patient make an informed decision regarding the screening.
6. The provider documents the counseling visit and the outcome of the shared decision making process.

4. When to use HCPCS code G0296

HCPCS code G0296 should be used when a counseling visit is conducted specifically to discuss the need for lung cancer screening using a low dose CT scan. It is important to note that this code is not applicable for the actual screening procedure itself, but rather for the visit that determines the patient’s eligibility and involves shared decision making.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G0296, healthcare providers need to document the counseling visit and the details of the shared decision making process. This includes documenting the discussion on the purpose and benefits of the screening, the assessment of the patient’s risk factors, and the outcome of the shared decision making. It is crucial to provide thorough documentation to support the medical necessity of the counseling visit.

6. Historical Information and Code Maintenance

HCPCS code G0296 was added to the Healthcare Common Procedure Coding System on February 05, 2015. Since its addition, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. This code has been in use since its introduction without any significant changes or revisions.

7. Medicare and Insurance Coverage

HCPCS code G0296 is payable by Medicare. The pricing indicator code 13 indicates that the price for this service is established by carriers, meaning it is not otherwise classified and is subject to individual determination and carrier discretion. The multiple pricing indicator code A signifies that this code is not applicable as HCPCS priced under one methodology. It is important for healthcare providers to verify coverage and reimbursement policies with other insurance carriers to ensure proper billing and reimbursement.

8. Examples

Here are five examples of when HCPCS code G0296 should be billed:

1. A patient with a history of smoking visits their primary care physician to discuss the need for lung cancer screening using a low dose CT scan. The physician assesses their eligibility and engages in shared decision making, resulting in a decision to proceed with the screening.
2. A healthcare provider conducts a counseling visit with a patient who has been identified as high risk for lung cancer due to occupational exposure. The visit focuses on determining their eligibility for the screening and discussing the potential benefits and risks.
3. A patient with a family history of lung cancer seeks counseling from an oncologist to understand their eligibility for lung cancer screening using a low dose CT scan. The oncologist provides detailed information and engages in shared decision making to help the patient make an informed choice.
4. A pulmonologist conducts a counseling visit with a patient who has recently quit smoking and wants to explore the option of lung cancer screening. The pulmonologist evaluates their eligibility and discusses the screening process, addressing any concerns or questions the patient may have.
5. A healthcare provider conducts a counseling visit with a patient who has been referred for lung cancer screening. The visit focuses on determining their eligibility and discussing the importance of shared decision making in the screening process.