Virtual Colonoscopy Reimbursement: Still ‘Virtual’ For Now
Posted on 27. Apr, 2009 by Editor in Provider News
Many cancer clinicians are all for virtual colonoscopy because they feel people are more likely to get colon cancer screenings if they have this less invasive option available. Most payers will not pay for virtual colonoscopy, however.
One major drawback to virtual colonoscopy from the payer perspective? If the physician spots an image of a polyp, she must do a separate procedure to biopsy or remove it, Dr. Bruce Rappaport explained to coders at AAPC’s Anatomy Expo. In an instrument colonoscopy, the physician is ‘already in there’ and can do a little surgery along the way.
In contrast, CT colonography (virtual colonoscopy or CTC) is an enhanced abdominal CT scan in which computer reconstruction allows radiologists to perform a detailed longitudinal 3D bowel examination for polyps, cancer, or other disease. This procedure uses helical computed tomography of the abdomen and pelvis, along with 3D reconstruction, to visualize the colon lumen. The test requires colonic preparation similar to that required for standard colonoscopy (instrument colonoscopy) and air insufflation to achieve colonic distention.
If you’re lucky enough to have a payer who reimburses for virtual colonoscopy, you’ll report CT colonography codes 0066T (Computed tomographic [CT] colonography [i.e.,virtual colonoscopy]; screening) or 0067T (… diagnostic).
And watch for virtual colonoscopy coverage policies to change. Medicare’s been getting some flak from seniors and cancer clinicians alike, Part B Insider reported earlier this spring.
Feb. 11, 2009 CMS announced a proposed decision memo saying that CT colonography for colorectal cancer screening ”remains noncovered.”
The response: CMS accepts public comments on proposed decisions. These comments are often dominated by letters from physicians and specialty societies. But the comments on the Feb 11 CT colonography (CTC) proposal include plenty of patients supporting coverage of this less invasive option. Their...
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