Beginning October 16, Medicare in four Midwestern states will pay for a virtual colonoscopy (CT colonography) exam after diagnostic colonoscopy fails for any reason. VC must be performed within two months of the incomplete colonoscopy.
The U.S. Centers for Medicare and Medicaid Services (CMS) Part B local coverage decision (LCD) for Region V, which covers Medicare patients in Illinois, Michigan, Minnesota, and Wisconsin, follows a public discussion period that began in the spring.
The LCD also authorizes an initial VC examination for two indications without the need for initial failed colonoscopy.
"CT colonography is also indicated for the evaluation of a submucosal abnormality detected on colonoscopy or other imaging study," according to the September 2005 Medicare Part B Communiqué. "(VC) is indicated for anticoagulated symptomatic patients in whom it is not safe to discontinue anticoagulant therapy." A PDF file of the publication is available at www.wpsmedicare.com.
Virtual colonoscopy is particularly well-suited for evaluating submucosal abnormalities, which cannot always be evaluated adequately with a colonoscope. And many doctors have warned that invasive conventional colonoscopy can be unsafe for patients on anticoagulant medications such as warfarin (Coumadin).
VC coverage does not apply when screening colonoscopy is incomplete for any reason. But the indications for diagnostic colonoscopy, which can lead to reimbursable VC when the colonoscope fails to reach the cecum, are fairly broad. They include a change in bowel habits, blood in the stool, diarrhea, nonspecific abnormal findings on a radiologic exam, and/or a personal history of colon polyps or cancer. By itself, a family history of colorectal cancer or polyps is insufficient for VC reimbursement.
Similarly, coverage is not provided when VC is chosen as an alternative to conventional colonoscopy, "even though performed for signs or symptoms of disease," according to the publication.
The screening of asymptomatic patients age 50 and older is considered the best potential use of virtual colonoscopy, which can diagnose colorectal and sometimes extracolonic disease, but cannot resect polyps as conventional colonoscopy can. So the coverage decision is only a small part of what Midwestern VC providers are hoping to eventually achieve.
"LCDs can't make coverage decisions for asymptomatic screening, but it's a good start," commented Dr. Perry Pickhardt, associate professor of radiology at the University of Wisconsin Medical School in Madison.
By Eric Barnes
AuntMinnie.com staff writer
August 30, 2005
Related Reading
Midwest weighs incremental Medicare gain for VC, May 26, 2005
VC practice thrives in Wisconsin, May 10, 2005
VC billing: Still hazy after all these years, November 19, 2004
VC gets long-awaited reporting standards, November 2, 2005
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