Radiology Coding Alert

Screening CT colonography (CTC) coverage is tricky business. For those payers who do cover it, you may have to jump through a few "necessity" hoops. And for other payers -- such as Medicare -- you won't see coverage.

A new decision memo makes it official for Medicare: www.cms.hhs.gov/mcd/viewdecisionmemo.asp?from2=viewdecisionmemo.asp&id=220&.

The American College of Radiology (ACR) responded to the decision with strong words: "For CMS to turn its back to a technology that can attract more patients to be screened and save countless lives is deeply concerning.

CMS should reverse this determination immediately or Congress should step in and vote to mandate coverage of CTC," said James H. Thrall, MD, FACR, chair of ACR's Board of Chancellors in a release ("CMS Denial of Coverage or CT Colonography May Cost Lives," www.acr.org/HomePageCategories/News/ACRNewsCenter/CMSDenialofCoverageforCTC.aspx).

ACR reports that "major insurers CIGNA and United-Healthcare already cover screening CT colonography nationwide while Anthem Blue Cross Blue Shield provides coverage in certain states."

Remember to report 0066T (Computed tomographic [CT] colonography [i.e., virtual colonoscopy]; screening) to these payers for screening CTC, and be sure you meet any payer requirements. For example, some payers may want documentation that medical reasons prevent the patient from undergoing traditional colonoscopy.