UH Lung Cancer Screening Update
October 14, 2019
Ongoing support, educational programs are available to referring physicians
Innovations in Pulmonology & Sleep Medicine | Fall 2019
With more than 4,000 patients already in its lung cancer screening program, University Hospitals is encouraging primary care physicians and specialists to refer patients who meet the eligibility requirements for screening.
The National Lung Cancer Screening Trial found that during six years of follow-up, qualifying adults who received three annual low-dose CT lung scans had a 20 percent reduction in relative risk of lung cancer death compared with those who received chest X-rays.
“The screening program is an effort to reduce the risk of dying of lung cancer by finding it sooner rather than later,” says Catalina Teba, MD, Division of Pulmonary, Critical Care and Sleep Medicine at University Hospitals Cleveland Medical Center.
A patient must meet all criteria to be eligible for University Hospitals CT scan lung cancer screening program.
- Age 55 to 77
- 30-pack/year smoking history
- Current smoker, or has quit within the past 15 years
- No symptoms
- Able to undergo treatment of lung cancer, if needed
- No other life-limiting illness
- Written order from his/her doctor
Multidisciplinary team. “In the last year, we’ve added monthly multidisciplinary meetings to discuss the higher-risk findings,” says Dr. Teba. “The team includes representatives from pulmonology, thoracic radiology, thoracic surgery, oncology and radiation oncology.”
These meetings provide guidance to primary providers on how to approach the management of lung nodules, lung masses and other findings from the lung cancer screening CT scans. UH also has developed notes for electronic medical records (EMRs) to make it easy to communicate with primary care providers about their patients.
Smoking cessation. Quitting smoking is the single most important thing individuals can do to improve their health, even if they’ve already been diagnosed with lung cancer.
UH is working closely with the University Hospitals Seidman Cancer Center’s TIPS (Tobacco Intervention and Psychosocial Support) program – a free, evidence-based tobacco cessation counseling and nicotine replacement therapy program for patients who are participating in the lung cancer screening program or who are undergoing cancer evaluation and treatment at UH Seidman Cancer Center and want to quit smoking.
Respiratory infections. Any patient with an active respiratory infection should wait 12 weeks after treatment to be screened, says Benjamin Young, MD, Director of Interventional Pulmonology, UH Cleveland Medical Center, and Assistant Professor of Pulmonary and Critical Care, Case Western Reserve University School of Medicine.
“Patients should not have any new respiratory symptoms that might be concerning for cancer or an active infection, such as a changing or new cough, weight loss, or hemoptysis when undergoing lung cancer screening,” says Dr. Young. “Active respiratory tract infections increase the risk of false positive screening results.”
Coding. Regardless of whether patients are on Medicare, UH uses CMS ICD-10 coding. When referring patients for lung cancer screening, use code Z87.891 (former smoker or history of nicotine dependence) or F17.210 (current smoker or nicotine dependent).
Follow-up. UH recommends referring patients who have a Lung-RADS (Lung CT Screening Reporting and Data System) of 3 or higher to pulmonary and thoracic surgery to assist with further evaluation.
Shared decision-making. Medicare Part B covers lung cancer screening for patients who meet all of the eligibility criteria. However, patients are required to participate in a documented counseling and shared decision-making meeting upon enrollment in the program and before initial screening.
Ongoing support and convenience. Karyn Markel, RN, BSN, Lung Cancer Nurse Coordinator, is happy to provide educational programs and other support to physicians who want to refer patients. In addition, UH offers lung cancer screening at multiple sites throughout the health system.
“We are trying to get patients seen close to where they live,” Markel says. “The most important component of the lung cancer screening program is follow-up, so making screening convenient is critical.”
For more information about the lung cancer screening program, or to enroll patients, contact Karyn Markel at 216-553-1649 or Karyn.Markel@UHHospitals.org.