General Surgery Coding Alert

Empire Medicare agrees to pay, and others could follow

Beginning January 1, 2005, providers billing Empire Medicare can report virtual colonoscopy using category III (temporary) codes 0066T (Computed tomographic [CT] colonography [i.e., virtual colonoscopy]; screening) or 0067T (Computed tomographic [CT] colonography [i.e., virtual colonoscopy]; diagnostic), as appropriate.

Empire Medicare Services has reversed its position on virtual colonoscopy, also known as CT colonography. In October 2003, Empire said it would never cover such procedures. But in a recent local coverage determination (LCD), Empire said it would cover virtual colonoscopy in circumstances when a regular colonoscopy fails.

You'll have to document the failed "instrument colonoscopy" to expect reimbursement for any virtual colonoscopy claims. "Virtual colonoscopy is reimbursable only when performed following an instrument colonoscopy which was incomplete due to an obstructing lesion," the Empire policy states. "Tests performed without a prior incomplete colonoscopy in history may be reviewed and denied."

Will other payers follow? Providers are hopeful the Empire policy will spark a reconsideration among other payers that will not cover virtual colonoscopy. Already, Cigna Healthcare has issued a draft LCD that duplicates Empire's, although Cigna's LCD refers to "fiber optic colonoscopy" instead of "instrument colonoscopy."

A patient might not be able to complete a standard colonoscopy for a variety of reasons, including hemophilia and unusual pain, notes Jeff Fulkerson, an independent coding expert in Atlanta. In addition, he notes, many patients would certainly prefer a quick non-invasive scan that doesn't leave them sore afterwards.