CMS Computed Tomographic (CT) Colonography for Diagnostic Uses Form

Summary Of Evidence

N/A

Analysis of Evidence

N/A

Abstract:

CT colonography, utilizes helical computed tomography of the abdomen and pelvis to visualize the colon lumen, along with 3-D reconstruction. The test requires colonic preparation similar to that required for standard colonoscopy (instrument colonoscopy), and air insufflation to achieve colonic distention.

Indications:

CT colonography is indicated in those patients in whom a diagnostic (performed for signs/symptoms of disease) optical colonoscopy of the entire colon is incomplete. Failure to complete the optical colonoscopy may be secondary to conditions such as, but not limited to, an obstructing neoplasm, stricture, tortuosity, spasm, redundant colon diverticulitis, extrinsic compression or aberrant anatomy scarring from prior surgery.

CT colonography is indicated when a board certified or board eligible gastroenterologist, a surgeon trained in endoscopy or a physician with equivalent endoscopic training determines from an evaluation of the patient that optical colonoscopy cannot be safely attempted.

CT colonography is also indicated for the evaluation of a submucosal abnormality detected on colonoscopy or other imaging study.

CT colonography should be performed soon after the failed standard colonoscopy, if appropriate, so that the patient will not have to endure repeat colonic preparation.

Limitations:

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

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

Irritable bowel syndrome and abdominal pain when representing chronic stable symptoms rarely represent reasonable indications for colonoscopy and CT colonography. These conditions have been placed on the list of covered diagnoses for use when a colonoscopy/colonography exam is normal in the face of compelling symptoms. When diagnosis codes representing these conditions are used, the codes must be applicable and the rationale for the colonoscopy/colonography must be carefully documented in the medical record.