Wisconsin Physicians Service Insurance (WPSI; Madison, Wisconsin) reported that four states in the Midwest have been selected as locales where virtual colonoscopy, or colonography, will be covered by Medicare when an attempt at traditional colonoscopy fails.
Those states include Illinois, Michigan, Minnesota and Wisconsin.
Bob Beckett, global product manager for diagnostic applications at GE Healthcare (Waukesha, Wisconsin), said that he was “excited” by the decision. “To have CMS approve [colonography] at the region level is a really, really big step for us,” Beckett told Diagnostics & Imaging Week. “Keep in mind, this is not for screening, this is for failed colonoscopy, but still, it was what we were hoping for.”
Beckett said that reimbursement comes “slowly,” but historically the pattern is for other regions of CMS to follow suit when a procedure is reimbursed in another region. “I would predict – this is just a prediction – but I think the Northeast would probably be next just because [area radiologists] have been pretty active in discussing this topic.”
He added, “What this means for the population of the U.S. is that it’s starting to be accepted; colonography is now being accepted as far as reimbursement for diagnostic applications.”
According to a Communiqu on Medicare Part B from the WPSI, virtual colonoscopy, or computed tomography (CT) colonography, uses helical CT of the abdomen and pelvis to visualize the colon lumen, along with 2-D or 3-D reconstruction.
“The test requires colonic preparation similar to that required for flexible colonoscopy, and air insufflation to achieve colonic distention,” the communique said. “Both 2D and 3D evaluation of a colon adequately distended and cleansed of stool should be performed using software and hardware designed for 2-D and 3-D evaluation.”
CT colonoscopy would still not be eligible for reimbursement simply as a preferred method for colon cancer screening over traditional colonoscopy, according to the communiqu , dated this month.
According to the communiqu , CT colonography is only indicated in those patients in whom a flexible colonoscopy of the entire colon that has been performed within the last two months is incomplete due to an inability to pass the colonoscope proximally.
“Failure to advance the colonoscope may be secondary to an obstructing neoplasm, stricture, tortuosity, redundant colon, diverticulitis, extrinsic compression or aberrant anatomy/scarring from prior surgery,” it said.
If a lesion is found during traditional colonoscopy, the WPSI said it should be removed and billed as a colonoscopy with biopsy removal. However, in that case, CT colon-oscopy would be indicated.
The communiqu said that CT colonography is “also indicated for the evaluation of a submucosal abnormality detected on colonoscopy or other imaging study” as a first-time choice. It also is indicated for patients who may be on blood thinners such as coumadin and are not recommended to be taken off that therapy for a traditional colonoscopy.
A CT colonography would not be covered in the absence of symptoms, regardless of family history or other risk factors.
In response to the decision, GE Healthcare said it is “committed to improving patient comfort during colon exams and providing clinicians with the best viewing capabilities to non-invasively screen for colon cancer and other clinically important conditions. “Today’s announcement by CMS is an important step toward the acceptance of virtual colonography as an alternative to standard colonoscopy,” GE said. “Unlike standard colonoscopy, which explores only the interior of the colon, virtual colonoscopy depicts the surrounding areas as well.”
GE said that in 2003 it had 45% of virtual colonography market share, making it the market leader. The company also noted that CT colonography demonstrates higher patient compliance from those who may not want to undergo a traditional colonoscopy exam. “Achieving high patient compliance is another step toward helping to prevent colon cancer, the No. 2 global cancer killer,” the company said. “According to the American Cancer Society [Atlanta], 90% of those who die from colon cancer can be saved with early detection.”
GE’s virtual colonoscopy device is the Advantage CTC, which provides 360-degree dissection view of the colon as an alternative to the standard 2-D or 3-D approach, the company said.