Current News At MDR

New Medicare Guidelines for Virtual Colonoscopy

Effective October 18, 2004, Medicare coverage in the New York Metropolitan Area (excluding Queens) for CT Colonography (Virtual Colonoscopy) has the following new determinations:

Indications

CT Colonography, also known as Virtual Colonoscopy, utilizes helical computed tomography of the abdomen and pelvis to visualize the colon lumen, along with 2D or 3D reconstruction. The test requires colonic preparation silimar to that required for fiberoptic colonoscopy, and air insufflation to achieve colonic distention.

CT Colonography is only indicated in those patients in whom a fiberoptic colonoscopy of the entire colon is incomplete due to an inability to pass the colonoscopy proximally. Failure to advance the colonoscopy may be secondary to an obstructing neoplasm, spasm, redundant colon, diverticulitis, extrinsic compression or aberrant anatomy/scarring from prior surgery.

Limitations

CT Colonography is not reimbursable when used for screening, or in the absence of signs or symptoms of disease, regardless of family history or other risk factors for the development of colonic disease.

CT Colonography is not reimbursable when used as an alternative to fiberoptic colonoscopy, for screening or in the absence of signs or symptoms of disease.

Since any colonography with abnormal or suspicious findings would require a subsequent fiberoptic colonoscopy for diagnosis (i.e., biopsy) or for treatment (i.e., polypectomy), CT Colonography is not reimbursable when used as an alternative to a fiberoptic colonoscopy, even though performed for signs or symptoms of disease.

For a complete listing of CPT and ICD-9 codes, please refer to www.medicare.gov.