CT Colonography (Virtual Colonoscopy [VC]) (L30300)
Contractor Information
|
Contractor Name Wisconsin Physicians Service Insurance Corporation |
Contractor Number 00951, 00952, 00953, 00954, 52280, 05101, 05201, 05301, 05401, 05102, 05202, 05302, 05402 |
Contractor Type Carrier - FI - MAC |
LCD Information
Document Information
L30300 LCD Title CT Colonography (Virtual Colonoscopy [VC]) Contractor's Determination Number RAD-035 AMA CPT/ADA CDT Copyright Statement CPT codes, descriptions and other data only are copyright 2011 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. |
Primary Geographic Jurisdiction
Oversight Region Original Determination Effective Date For services performed on or after 11/15/2009 Original Determination Ending Date Revision Effective Date For services performed on or after 10/01/2011 Revision Ending Date |
CMS National Coverage Policy
CMS Pub.100-2 Ch.15 §80
Indications and Limitations of Coverage and/or Medical Necessity
Indications
1. CT colonography also known as "Virtual Colonoscopy" (VC) utilizes helical computed tomography of the abdomen and pelvis to visualize the colon lumen, along with 2D or 3D reconstruction. The test requires colonic preparation similar to that required for flexible colonoscopy, and air insufflation to achieve colonic distention. Both 2D and 3D evaluation of a colon adequately distended and cleansed of stool should be performed using software and hardware designed for 2D and 3D evaluation.
2. CT colonography is indicated in those patients in whom a diagnostic (performed for signs/symptoms of disease) optical colonoscopy (OC) of the entire colon is incomplete. Failure to complete the OC 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.
3. CT colonography is indicated when utilized in pre-operative cancer staging and the determination of colonic wall invasion.
4. If during the course of a screening OC a condition is found, or a complication is encountered which results in the conversion of the screening OC into a diagnostic OC, and the diagnostic OC cannot be completed because of complicating conditions (see #2 above), VC would be covered.
5. CT colonography is also indicated for the evaluation of a submucosal abnormality detected on colonoscopy or other imaging study.
6. CT colonography is indicated in patients with serious coagulopathies and anticoagulated patients in whom it would be hazardous to discontinue anticoagulation therapy.
7. In patients with a history of previous incomplete OC and/or serious complication during OC, the reason for such incomplete and/or complicated OC being a condition which is unlikely to improve (extreme tortuosity, abdominal adhesions, etc.), CT colonography is covered as an alternative to diagnostic (not screening ) OC.
8. In patients with previously documented, usually by barium enema, conditions which make OC unsafe (extreme tortuosity, etc), CT colonography is covered as an alternative to diagnostic (not screening) OC.
Limitations
1. The screening colonoscopy benefit being under national (CMS) authority and, therefore, not under Carrier discretion, CT colonography is never covered, under the auspices of this LCD, when screening (in the absence of signs or symptoms of disease) OC is incomplete due to any of the above reasons,
2. CT colonography is never covered when used for screening (in the absence of signs or symptoms of disease) regardless of family history or other risk factors for the development of colonic disease.
3. CT colonography is never covered when used as an elective alternative to OC, for screening (in the absence of signs or symptoms of disease).
4. Since any CT colonography showing abnormal or suspicious findings would require a subsequent OC for diagnosis (e.g., biopsy) or for treatment (e.g., polypectomy), CT colonography is never covered when used as an elective alternative to OC, even though performed for signs or symptoms of disease (diagnostic OC).
1. CT colonography also known as "Virtual Colonoscopy" (VC) utilizes helical computed tomography of the abdomen and pelvis to visualize the colon lumen, along with 2D or 3D reconstruction. The test requires colonic preparation similar to that required for flexible colonoscopy, and air insufflation to achieve colonic distention. Both 2D and 3D evaluation of a colon adequately distended and cleansed of stool should be performed using software and hardware designed for 2D and 3D evaluation.
2. CT colonography is indicated in those patients in whom a diagnostic (performed for signs/symptoms of disease) optical colonoscopy (OC) of the entire colon is incomplete. Failure to complete the OC 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.
3. CT colonography is indicated when utilized in pre-operative cancer staging and the determination of colonic wall invasion.
4. If during the course of a screening OC a condition is found, or a complication is encountered which results in the conversion of the screening OC into a diagnostic OC, and the diagnostic OC cannot be completed because of complicating conditions (see #2 above), VC would be covered.
5. CT colonography is also indicated for the evaluation of a submucosal abnormality detected on colonoscopy or other imaging study.
6. CT colonography is indicated in patients with serious coagulopathies and anticoagulated patients in whom it would be hazardous to discontinue anticoagulation therapy.
7. In patients with a history of previous incomplete OC and/or serious complication during OC, the reason for such incomplete and/or complicated OC being a condition which is unlikely to improve (extreme tortuosity, abdominal adhesions, etc.), CT colonography is covered as an alternative to diagnostic (not screening ) OC.
8. In patients with previously documented, usually by barium enema, conditions which make OC unsafe (extreme tortuosity, etc), CT colonography is covered as an alternative to diagnostic (not screening) OC.
Limitations
1. The screening colonoscopy benefit being under national (CMS) authority and, therefore, not under Carrier discretion, CT colonography is never covered, under the auspices of this LCD, when screening (in the absence of signs or symptoms of disease) OC is incomplete due to any of the above reasons,
2. CT colonography is never covered when used for screening (in the absence of signs or symptoms of disease) regardless of family history or other risk factors for the development of colonic disease.
3. CT colonography is never covered when used as an elective alternative to OC, for screening (in the absence of signs or symptoms of disease).
4. Since any CT colonography showing abnormal or suspicious findings would require a subsequent OC for diagnosis (e.g., biopsy) or for treatment (e.g., polypectomy), CT colonography is never covered when used as an elective alternative to OC, even though performed for signs or symptoms of disease (diagnostic OC).
Coding Information
Bill Type Codes:
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
Revenue Codes:
CPT/HCPCS Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.74263 Not covered by statute Screening
| 74261 | COMPUTED TOMOGRAPHIC (CT) COLONOGRAPHY, DIAGNOSTIC, INCLUDING IMAGE POSTPROCESSING; WITHOUT CONTRAST MATERIAL |
| 74262 | COMPUTED TOMOGRAPHIC (CT) COLONOGRAPHY, DIAGNOSTIC, INCLUDING IMAGE POSTPROCESSING; WITH CONTRAST MATERIAL(S) INCLUDING NON-CONTRAST IMAGES, IF PERFORMED |
| 74263 | COMPUTED TOMOGRAPHIC (CT) COLONOGRAPHY, SCREENING, INCLUDING IMAGE POSTPROCESSING |
ICD-9 Codes that Support Medical Necessity
The correct use of an ICD-9-CM code listed below does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in this determination.
| 006.1 | CHRONIC INTESTINAL AMEBIASIS WITHOUT ABSCESS |
| 006.2 | AMEBIC NONDYSENTERIC COLITIS |
| 006.9 | AMEBIASIS UNSPECIFIED |
| 009.0 - 009.3 | INFECTIOUS COLITIS ENTERITIS AND GASTROENTERITIS - DIARRHEA OF PRESUMED INFECTIOUS ORIGIN |
| 014.00 | TUBERCULOUS PERITONITIS UNSPECIFIED EXAMINATION |
| 014.86 | OTHER TUBERCULOSIS OF INTESTINES AND MESENTERIC GLANDS TUBERCLE BACILLI NOT FOUND BY BACTERIOLOGICAL OR HISTOLOGICAL EXAMINATION BUT TUBERCULOSIS CONFIRMED BY OTHER METHODS (INOCULATION OF ANIMALS) |
| 153.0 - 153.9 | MALIGNANT NEOPLASM OF HEPATIC FLEXURE - MALIGNANT NEOPLASM OF COLON UNSPECIFIED SITE |
| 154.0 - 154.8 | MALIGNANT NEOPLASM OF RECTOSIGMOID JUNCTION - MALIGNANT NEOPLASM OF OTHER SITES OF RECTUM RECTOSIGMOID JUNCTION AND ANUS |
| 159.0 | MALIGNANT NEOPLASM OF INTESTINAL TRACT PART UNSPECIFIED |
| 159.8 | MALIGNANT NEOPLASM OF OTHER SITES OF DIGESTIVE SYSTEM AND INTRA-ABDOMINAL ORGANS |
| 196.2 | SECONDARY AND UNSPECIFIED MALIGNANT NEOPLASM OF INTRA-ABDOMINAL LYMPH NODES |
| 197.5 | SECONDARY MALIGNANT NEOPLASM OF LARGE INTESTINE AND RECTUM |
| 197.7 | MALIGNANT NEOPLASM OF LIVER SECONDARY |
| 211.3 | BENIGN NEOPLASM OF COLON |
| 211.4 | BENIGN NEOPLASM OF RECTUM AND ANAL CANAL |
| 230.0 - 230.6 | CARCINOMA IN SITU OF LIP ORAL CAVITY AND PHARYNX - CARCINOMA IN SITU OF ANUS UNSPECIFIED |
| 235.2 | NEOPLASM OF UNCERTAIN BEHAVIOR OF STOMACH INTESTINES AND RECTUM |
| 235.5 | NEOPLASM OF UNCERTAIN BEHAVIOR OF OTHER AND UNSPECIFIED DIGESTIVE ORGANS |
| 239.0 | NEOPLASM OF UNSPECIFIED NATURE OF DIGESTIVE SYSTEM |
| 280.0 | IRON DEFICIENCY ANEMIA SECONDARY TO BLOOD LOSS (CHRONIC) |
| 280.9 | IRON DEFICIENCY ANEMIA UNSPECIFIED |
| 286.0 | CONGENITAL FACTOR VIII DISORDER |
| 286.1 | CONGENITAL FACTOR IX DISORDER |
| 286.2 | CONGENITAL FACTOR XI DEFICIENCY |
| 286.3 | CONGENITAL DEFICIENCY OF OTHER CLOTTING FACTORS |
| 286.4 | VON WILLEBRAND'S DISEASE |
| 286.52 | ACQUIRED HEMOPHILIA |
| 286.53 | ANTIPHOSPHOLIPID ANTIBODY WITH HEMORRHAGIC DISORDER |
| 286.59 | OTHER HEMORRHAGIC DISORDER DUE TO INTRINSIC CIRCULATING ANTICOAGULANTS, ANTIBODIES, OR INHIBITORS |
| 286.6 | DEFIBRINATION SYNDROME |
| 286.7 | ACQUIRED COAGULATION FACTOR DEFICIENCY |
| 286.9 | OTHER AND UNSPECIFIED COAGULATION DEFECTS |
| 555.0 - 555.9 | REGIONAL ENTERITIS OF SMALL INTESTINE - REGIONAL ENTERITIS OF UNSPECIFIED SITE |
| 556.0 - 556.9 | ULCERATIVE (CHRONIC) ENTEROCOLITIS - ULCERATIVE COLITIS UNSPECIFIED |
| 557.0 - 557.9 | ACUTE VASCULAR INSUFFICIENCY OF INTESTINE - UNSPECIFIED VASCULAR INSUFFICIENCY OF INTESTINE |
| 558.1 - 558.9 | GASTROENTERITIS AND COLITIS DUE TO RADIATION - OTHER AND UNSPECIFIED NONINFECTIOUS GASTROENTERITIS AND COLITIS |
| 560.0 | INTUSSUSCEPTION |
| 560.1 | PARALYTIC ILEUS |
| 560.2 | VOLVULUS |
| 560.81 | INTESTINAL OR PERITONEAL ADHESIONS WITH OBSTRUCTION (POSTOPERATIVE) (POSTINFECTION) |
| 560.89 | OTHER SPECIFIED INTESTINAL OBSTRUCTION |
| 560.9 | UNSPECIFIED INTESTINAL OBSTRUCTION |
| 562.10 - 562.13 | DIVERTICULOSIS OF COLON (WITHOUT HEMORRHAGE) - DIVERTICULITIS OF COLON WITH HEMORRHAGE |
| 564.4 - 564.89 | OTHER POSTOPERATIVE FUNCTIONAL DISORDERS - OTHER FUNCTIONAL DISORDERS OF INTESTINE |
| 569.0 | ANAL AND RECTAL POLYP |
| 569.3 | HEMORRHAGE OF RECTUM AND ANUS |
| 569.81 - 569.89 | FISTULA OF INTESTINE EXCLUDING RECTUM AND ANUS - OTHER SPECIFIED DISORDERS OF INTESTINES |
| 578.1 | BLOOD IN STOOL |
| 578.9 | HEMORRHAGE OF GASTROINTESTINAL TRACT UNSPECIFIED |
| 596.1 | INTESTINOVESICAL FISTULA |
| 619.1 | DIGESTIVE-GENITAL TRACT FISTULA FEMALE |
| 759.6 | OTHER CONGENITAL HAMARTOSES NOT ELSEWHERE CLASSIFIED |
| 787.91 | DIARRHEA |
| 787.99 | OTHER SYMPTOMS INVOLVING DIGESTIVE SYSTEM |
| 792.1 | NONSPECIFIC ABNORMAL FINDINGS IN STOOL CONTENTS |
| 793.4 | NONSPECIFIC (ABNORMAL) FINDINGS ON RADIOLOGICAL AND OTHER EXAMINATION OF GASTROINTESTINAL TRACT |
| 936 | FOREIGN BODY IN INTESTINE AND COLON |
| 937 | FOREIGN BODY IN ANUS AND RECTUM |
| V10.00 | PERSONAL HISTORY OF MALIGNANT NEOPLASM OF UNSPECIFIED SITE IN GASTROINTESTINAL TRACT |
| V10.03 | PERSONAL HISTORY OF MALIGNANT NEOPLASM OF ESOPHAGUS |
| V10.04 | PERSONAL HISTORY OF MALIGNANT NEOPLASM OF STOMACH |
| V10.05 | PERSONAL HISTORY OF MALIGNANT NEOPLASM OF LARGE INTESTINE |
| V10.06 | PERSONAL HISTORY OF MALIGNANT NEOPLASM OF RECTUM RECTOSIGMOID JUNCTION AND ANUS |
| V10.07 | PERSONAL HISTORY OF MALIGNANT NEOPLASM OF LIVER |
| V12.70 | PERSONAL HISTORY OF UNSPECIFIED DIGESTIVE DISEASE |
| V12.72 | PERSONAL HISTORY OF COLONIC POLYPS |
Diagnoses that Support Medical Necessity
Any listed above
ICD-9 Codes that DO NOT Support Medical Necessity
| V10.09 | PERSONAL HISTORY OF MALIGNANT NEOPLASM OF OTHER SITES IN GASTROINTESTINAL TRACT |
| V12.79 | PERSONAL HISTORY OF OTHER SPECIFIED DIGESTIVE SYSTEM DISEASES |
| V16.0 | FAMILY HISTORY OF MALIGNANT NEOPLASM OF GASTROINTESTINAL TRACT |
| V18.51 | FAMILY HISTORY, COLONIC POLYPS |
| V72.5 | RADIOLOGICAL EXAMINATION NOT ELSEWHERE CLASSIFIED |
| V76.41 | SCREENING FOR MALIGNANT NEOPLASMS OF THE RECTUM |
| V76.51 | SPECIAL SCREENING FOR MALIGNANT NEOPLASMS COLON |
ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation
Diagnoses that DO NOT Support Medical Necessity
Any listed above
General Information
Physicians' Services
and diagnostic tests must be submitted with an ICD-9 code to support
the medical necessity for the service and must be coded to the greatest
level of accuracy and highest level of digit completeness. This means
the precise ICD-9 code that fully explains the narrative description of
the diagnosis contained in the medical record or the test interpretation
and report including the 4th or 5th digit sub-classification for the
diagnosis category. The ICD-9 code based on the results of the test
should be the primary diagnosis. If the diagnostic test results are
normal or inconclusive the ICD-9 code representing the sign, symptom,
illness or injury prompting the ordering of the test should be reported
as the primary diagnosis. In the absence of signs, symptoms, illness or
injury a screening diagnosis should be reported, and payment will be
denied
2. The order/prescription from the referring physicians must be retained in the patient's medical records.
3. Medical records must be available to document a conventional colonoscopy has failed or documentation supporting the contraindication to an optical colonoscopy. These records must be available upon request.
4. Medical records should be legible, contain all the history and physical finding listed in the "Indication and Limitations of Coverage and/or Medical Necessity" section above and must be available to the Carrier upon request.
Appendices
2. The order/prescription from the referring physicians must be retained in the patient's medical records.
3. Medical records must be available to document a conventional colonoscopy has failed or documentation supporting the contraindication to an optical colonoscopy. These records must be available upon request.
4. Medical records should be legible, contain all the history and physical finding listed in the "Indication and Limitations of Coverage and/or Medical Necessity" section above and must be available to the Carrier upon request.
CT colonography is
reasonable and necessary when performed following an incomplete flexible
colonoscopy, due to obstruction or in patients with conditions or
circumstances described in the indications portion of this document.
Sources of Information and Basis for Decision
1. "Virtual
Colonoscopy (CT Colonography) as a Screening Test for Colorectal Cancer"
The Regence Group at
http://blue.regence.com/trgmedpol/radiology/rad36.html
2. CareFirst Blue Cross and Blue Shield of Maryland Medicare Coverage Database article #A14699
3. Morrin, M.M., Kruskal, J.B., Farrell, R.J., Goldberg, S.N., McGee, J.B., Raptopoulos, V., et al, "Endoluminal CT Colonography After an Incomplete Endoscoptic Colonoscopy", AJR 172:913-918 (April 1999).
4. Fenlon, H.M., et al, "Occlusive Colon Carcinoma: Virtual Colonoscopy in the Preoperative Evaluation of the Proximal Colon", Radiology 210:423-428 (February 1999).
5. Johnson, C.D., et al, "Prospective Blinded Comparison of CT Colonography and Double Contrast Barium Enema for Screen-Detection of Colorectal Polyps", abstract Abdominal Radiology course 2003, The 32nd Annual Postgraduate Course and Scientific Meeting of The Society of Gastrointestinal Radiologists and the 28th Scientific Assembly of The Society of Uroradiology.
6. Cotton, P.B., Durkalski, V.L., Pineau, B.C., et al, "Computed Tomographic Colonography Virtual Colonoscopy", JAMA 291:1713-1719 (April 14, 2004).
7. Ransohoff, D.F., Virtual Colonoscopy - "What It Can Do vs What It Will Do" JAMA 291:1772-1774 (April 14, 2004).
8. Pickhardt, P.J., Choi, J.R., Hwang, I., et al, "Computed Tomographic Virtual Colonoscopy to Screen for Colorectal Neoplasia in Asymptomatic Adults" NEJM 349(23):2191-2200 (December 4, 2003).
9. Laghi, A., et al, "Detection of Colorectal Lesions with Virtual Computed Tomographic Colonoscopy" AMJ Surgery 183:124-131 (2002).
10. Laghi, A., Innaccone, R., Carbone, I., et al, "Computed Tomographic Colonography (Virtual Colonoscopy): Blinded Prospective Comparison with Conventional Colonoscopy for the Detection of Colorectal Neoplasia", Endoscopy 34:441-446 (2002).
11. Gluecker, et al, "Colorectal Cancer Screening with CT Colonography, Colonoscopy, and Double Contrast Barium Enema Examination: Prospective Assessment of Patient Perception and Preferences", Radiology, May 2003, Volume 227 - Number 2, pages 378-384.
12. Macari, et al "Colorectal Neoplasms: Prospective Comparison of Thin-Section Low Dose Multi-Detector Row CT Colonography and Conventional Colonoscopy for Detection." Radiology, August 2002, Volume 224- Number 2, pages 383-392.
13. Neri, E. et al. "Colorectal Cancer: Role of CT Colonography in Preoperative Evaluation after Incomplete Colonoscopy"; Radiology, 2002, 223: 615-619.
14. Johnson, C.D., Harmsen, W.S., Wilson, L.A., et al. "Prospective Blind Evaluation of Computed Tomographic Colonography for Screen Detection of Colorectal Polyps"; Gastroenterology 2003; 125:311-319
15. Sosna, J. et al. "CT Colonography of Colorectal Polyps: A Metaanalysis". AJR 2003;181:1593-1598
16. Fenlon, H.M., Nunes, D.P., Schroy, P.C. III, Barish, M.A., Clarke, P.D., Ferrucci, J.T., "A Comparison for Virtual and Conventional Colonoscopy for the Detection of Colorectal Polyps". NEJM 1999;341:1540-1542
17. Yee, J. et al. "Colorectal Neoplasis: Performance Characteristics of CT Colonography for Detection in 300 Patients". Radiology 2001; 219:685-692
18. Munikrishnan, V., Gilliams, A.R., Lee, W.R., Vaizey, C.J., Boulos, P.B., "Prospective Study Comparing Multislice CT Colonography with Colonoscopy in the Detection of Colorectal Cancer and Polyps". Dis Colon Rectum 2003; 46:1384-1390
19. Iannaccone, R., Laghi, A., Catalano, C., et al. "Detection of Colorectal Lesions; Low-Dose Multidetector Row Helical CT Colonography Compared with Conventional Colonoscopy". Radiology 2003; 229: 775-781
20. Wong, B.C., Wong, W.M., Chan, J.K., et al. "Virtual Colonoscopy for the Detection of Colorectal Polyps and Cancer in a Chinese Population"; J Gastroenterology Hepatol 2002; 17:1323-1327
21. Miao, Y.M., Amin, Z., Healy, J., et al. "A Prospective Single Center Study Comparing Computed Tomography Pneumcolon Against Colonoscopy in the Detection of Colorectal Neoplasms"; Gut 2000; 47:832-837
22. Bressler, B., Paszat, L.F., Vinden, C., et al. "Colonoscopic Miss Rate for Right-Sided Colon Cancer: A Population-Based Analysis". Gastroenterology 2004;127 :452-456
23. Pickhardt, P.J., Nugent, P.A., Mysliwiec, P.A., Choi, J.R., Schindler. W.R.., "Locations of Adenomas Missed as Optical Colonoscopy". Ann Intern Med 2004; 141:352-359
24. Van Gelder, R.E., Nio, C.Y., Florie, J., et al. "Computed Tomographic Colonography Compared with Colonoscopy in Patients as Risk for Colorectal Cancer"; Gastroenterology 2004;127:41-48
25. Marcari, M., Berman, P., Dicker, M., Milano, A., Megibow, A.J., "Usefulness of CT Colonography in Patients with Incomplete Colonoscopy". AJR 1999; 173:561-564
26. Kamar, M., Portnoy, O., Bar-Dayan, A., et al. "Actual Perforation in Virtual Colonoscopy: Report of a Case". Dis Colon rectum 2004; 47:1242-1244
27. Coady-Fariborzian, L., Angel, L.P., Procaccino, A.J., "Perforated Colon Secondary to Virtual Colonoscopy: Report of a Case". Dis Colon Rectum 2004; 47:1247-1249
28. Pickhardt, P.J., "Differential Diagnosis of Polypoid Lesions Seen at CT Colonography (Virtual Colonoscopy)". RadioGraphica 2004 (Nov)
29. Pickhardt, P.J., "Three-dimensional Endoluminal CT Colonography (Virtual Colonoscopy): Comparison of Three Commercially Available Systems". AJR 2003; 181:1599-1606
30. Morrin M et al. Roll of Virtual Computed Tomographic Colonoscopy in Patients with Colorectal Cancers and Obstructive Colorectal Lesions. Dis Colon Rectum 2000; 43(3): 303-311.
31. Filippone A et al. Preoperative T and N Staging of Colorectal Cancer: Accuracy of Contrast-enhanced Multi-Detector Row CT Colonography-Initial Experience. Radiology 2004; 231: 83-90.
32. Hellstrom M, Svensson MH, and Lasson A;. "Extracolonic and Incidental Findings on CT Colonography (Virtual Colonoscopy)"; AJR 2004; 182: 631-638.
Advisory Committee Meeting Notes
2. CareFirst Blue Cross and Blue Shield of Maryland Medicare Coverage Database article #A14699
3. Morrin, M.M., Kruskal, J.B., Farrell, R.J., Goldberg, S.N., McGee, J.B., Raptopoulos, V., et al, "Endoluminal CT Colonography After an Incomplete Endoscoptic Colonoscopy", AJR 172:913-918 (April 1999).
4. Fenlon, H.M., et al, "Occlusive Colon Carcinoma: Virtual Colonoscopy in the Preoperative Evaluation of the Proximal Colon", Radiology 210:423-428 (February 1999).
5. Johnson, C.D., et al, "Prospective Blinded Comparison of CT Colonography and Double Contrast Barium Enema for Screen-Detection of Colorectal Polyps", abstract Abdominal Radiology course 2003, The 32nd Annual Postgraduate Course and Scientific Meeting of The Society of Gastrointestinal Radiologists and the 28th Scientific Assembly of The Society of Uroradiology.
6. Cotton, P.B., Durkalski, V.L., Pineau, B.C., et al, "Computed Tomographic Colonography Virtual Colonoscopy", JAMA 291:1713-1719 (April 14, 2004).
7. Ransohoff, D.F., Virtual Colonoscopy - "What It Can Do vs What It Will Do" JAMA 291:1772-1774 (April 14, 2004).
8. Pickhardt, P.J., Choi, J.R., Hwang, I., et al, "Computed Tomographic Virtual Colonoscopy to Screen for Colorectal Neoplasia in Asymptomatic Adults" NEJM 349(23):2191-2200 (December 4, 2003).
9. Laghi, A., et al, "Detection of Colorectal Lesions with Virtual Computed Tomographic Colonoscopy" AMJ Surgery 183:124-131 (2002).
10. Laghi, A., Innaccone, R., Carbone, I., et al, "Computed Tomographic Colonography (Virtual Colonoscopy): Blinded Prospective Comparison with Conventional Colonoscopy for the Detection of Colorectal Neoplasia", Endoscopy 34:441-446 (2002).
11. Gluecker, et al, "Colorectal Cancer Screening with CT Colonography, Colonoscopy, and Double Contrast Barium Enema Examination: Prospective Assessment of Patient Perception and Preferences", Radiology, May 2003, Volume 227 - Number 2, pages 378-384.
12. Macari, et al "Colorectal Neoplasms: Prospective Comparison of Thin-Section Low Dose Multi-Detector Row CT Colonography and Conventional Colonoscopy for Detection." Radiology, August 2002, Volume 224- Number 2, pages 383-392.
13. Neri, E. et al. "Colorectal Cancer: Role of CT Colonography in Preoperative Evaluation after Incomplete Colonoscopy"; Radiology, 2002, 223: 615-619.
14. Johnson, C.D., Harmsen, W.S., Wilson, L.A., et al. "Prospective Blind Evaluation of Computed Tomographic Colonography for Screen Detection of Colorectal Polyps"; Gastroenterology 2003; 125:311-319
15. Sosna, J. et al. "CT Colonography of Colorectal Polyps: A Metaanalysis". AJR 2003;181:1593-1598
16. Fenlon, H.M., Nunes, D.P., Schroy, P.C. III, Barish, M.A., Clarke, P.D., Ferrucci, J.T., "A Comparison for Virtual and Conventional Colonoscopy for the Detection of Colorectal Polyps". NEJM 1999;341:1540-1542
17. Yee, J. et al. "Colorectal Neoplasis: Performance Characteristics of CT Colonography for Detection in 300 Patients". Radiology 2001; 219:685-692
18. Munikrishnan, V., Gilliams, A.R., Lee, W.R., Vaizey, C.J., Boulos, P.B., "Prospective Study Comparing Multislice CT Colonography with Colonoscopy in the Detection of Colorectal Cancer and Polyps". Dis Colon Rectum 2003; 46:1384-1390
19. Iannaccone, R., Laghi, A., Catalano, C., et al. "Detection of Colorectal Lesions; Low-Dose Multidetector Row Helical CT Colonography Compared with Conventional Colonoscopy". Radiology 2003; 229: 775-781
20. Wong, B.C., Wong, W.M., Chan, J.K., et al. "Virtual Colonoscopy for the Detection of Colorectal Polyps and Cancer in a Chinese Population"; J Gastroenterology Hepatol 2002; 17:1323-1327
21. Miao, Y.M., Amin, Z., Healy, J., et al. "A Prospective Single Center Study Comparing Computed Tomography Pneumcolon Against Colonoscopy in the Detection of Colorectal Neoplasms"; Gut 2000; 47:832-837
22. Bressler, B., Paszat, L.F., Vinden, C., et al. "Colonoscopic Miss Rate for Right-Sided Colon Cancer: A Population-Based Analysis". Gastroenterology 2004;127 :452-456
23. Pickhardt, P.J., Nugent, P.A., Mysliwiec, P.A., Choi, J.R., Schindler. W.R.., "Locations of Adenomas Missed as Optical Colonoscopy". Ann Intern Med 2004; 141:352-359
24. Van Gelder, R.E., Nio, C.Y., Florie, J., et al. "Computed Tomographic Colonography Compared with Colonoscopy in Patients as Risk for Colorectal Cancer"; Gastroenterology 2004;127:41-48
25. Marcari, M., Berman, P., Dicker, M., Milano, A., Megibow, A.J., "Usefulness of CT Colonography in Patients with Incomplete Colonoscopy". AJR 1999; 173:561-564
26. Kamar, M., Portnoy, O., Bar-Dayan, A., et al. "Actual Perforation in Virtual Colonoscopy: Report of a Case". Dis Colon rectum 2004; 47:1242-1244
27. Coady-Fariborzian, L., Angel, L.P., Procaccino, A.J., "Perforated Colon Secondary to Virtual Colonoscopy: Report of a Case". Dis Colon Rectum 2004; 47:1247-1249
28. Pickhardt, P.J., "Differential Diagnosis of Polypoid Lesions Seen at CT Colonography (Virtual Colonoscopy)". RadioGraphica 2004 (Nov)
29. Pickhardt, P.J., "Three-dimensional Endoluminal CT Colonography (Virtual Colonoscopy): Comparison of Three Commercially Available Systems". AJR 2003; 181:1599-1606
30. Morrin M et al. Roll of Virtual Computed Tomographic Colonoscopy in Patients with Colorectal Cancers and Obstructive Colorectal Lesions. Dis Colon Rectum 2000; 43(3): 303-311.
31. Filippone A et al. Preoperative T and N Staging of Colorectal Cancer: Accuracy of Contrast-enhanced Multi-Detector Row CT Colonography-Initial Experience. Radiology 2004; 231: 83-90.
32. Hellstrom M, Svensson MH, and Lasson A;. "Extracolonic and Incidental Findings on CT Colonography (Virtual Colonoscopy)"; AJR 2004; 182: 631-638.
Meeting Date:
Wisconsin: 01/16/2009
Illinois: 01/28/2009
Michigan: 01/07/2009
Minnesota: 01/22/2009
J-5 MAC (IA,KS,MO, NE) 02/12/2009
Start Date of Comment Period
Wisconsin: 01/16/2009
Illinois: 01/28/2009
Michigan: 01/07/2009
Minnesota: 01/22/2009
J-5 MAC (IA,KS,MO, NE) 02/12/2009
02/12/2009
End Date of Comment Period
03/30/2009
Start Date of Notice Period
01/01/2010
Revision History Number
X
Revision History Explanation
09/23/2009 Released
to final. Will be effective as L30300 on November 15, 2009. Replaces
L19899
L19902
L19904
L19906
L26704
06/30/2009 The contractor number 05392 will no longer be valid as of 8/1/2009 as it will be joining with the W MO number.
08/08/2009 - This policy was updated by the ICD-9 2009-2010 Annual Update.
11/15/2009 - CPT/HCPCS code 0066T was deleted from group 1
11/15/2009 - CPT/HCPCS code 0067T was deleted from group 1
04/19/2010 - In accordance with Section 911 of the Medicare Modernization Act of 2003, the states of American Somoa, California, Guam, Hawaii, Nevada and Northern Mariana Islands were removed from this LCD because claims processing for those states are transitioning from FI Contractor Wisconsin Physician Services (WPS - 52280) to MAC Part A Contractor Palmetto.
10/18/2010 - In accordance with Section 911 of the Medicare Modernization Act of 2003, the states of Colorado, New Mexico, Oklahoma and Texas were removed from this LCD because claims processing for those states are transitioning from FI Wisconsin Physicians Service (52280) to MAC Part A Trailblazer (04901).
11/21/2010 - For the following CPT/HCPCS codes either the short description and/or the long description was changed. Depending on which description is used in this LCD, there may not be any change in how the code displays in the document:
74261 descriptor was changed in Group 1
74262 descriptor was changed in Group 1
74263 descriptor was changed in Group 1
01/01/10- Added 74261-74263, deleted codes 0066T, 0067T; removed "within 30 days" from documentation requirement #3
02/21/2011 - In accordance with Section 911 of the Medicare Modernization Act of 2003, the states of Delaware, District of Columbia, Maryland, New Jersey and Pennsylvania were removed from this LCD because claims processing for these states are transitioning from FI Wisconsin Physician Service (WPS 52280) to MAC Part A contractor Highmark (12901).
03/01/2011-Annual review, no change to coverage
08/27/2011 - This policy was updated by the ICD-9 2011-2012 Annual Update.
10/01/2011 - 2012-ICD-9 code update article published-added 286.52, 286.53, 286.59.
Reason for Change
L19899
L19902
L19904
L19906
L26704
06/30/2009 The contractor number 05392 will no longer be valid as of 8/1/2009 as it will be joining with the W MO number.
08/08/2009 - This policy was updated by the ICD-9 2009-2010 Annual Update.
11/15/2009 - CPT/HCPCS code 0066T was deleted from group 1
11/15/2009 - CPT/HCPCS code 0067T was deleted from group 1
04/19/2010 - In accordance with Section 911 of the Medicare Modernization Act of 2003, the states of American Somoa, California, Guam, Hawaii, Nevada and Northern Mariana Islands were removed from this LCD because claims processing for those states are transitioning from FI Contractor Wisconsin Physician Services (WPS - 52280) to MAC Part A Contractor Palmetto.
10/18/2010 - In accordance with Section 911 of the Medicare Modernization Act of 2003, the states of Colorado, New Mexico, Oklahoma and Texas were removed from this LCD because claims processing for those states are transitioning from FI Wisconsin Physicians Service (52280) to MAC Part A Trailblazer (04901).
11/21/2010 - For the following CPT/HCPCS codes either the short description and/or the long description was changed. Depending on which description is used in this LCD, there may not be any change in how the code displays in the document:
74261 descriptor was changed in Group 1
74262 descriptor was changed in Group 1
74263 descriptor was changed in Group 1
01/01/10- Added 74261-74263, deleted codes 0066T, 0067T; removed "within 30 days" from documentation requirement #3
02/21/2011 - In accordance with Section 911 of the Medicare Modernization Act of 2003, the states of Delaware, District of Columbia, Maryland, New Jersey and Pennsylvania were removed from this LCD because claims processing for these states are transitioning from FI Wisconsin Physician Service (WPS 52280) to MAC Part A contractor Highmark (12901).
03/01/2011-Annual review, no change to coverage
08/27/2011 - This policy was updated by the ICD-9 2011-2012 Annual Update.
10/01/2011 - 2012-ICD-9 code update article published-added 286.52, 286.53, 286.59.
This LCD has no Related Documents.
LCD Attachments
Billing & Coding Guidelines 10/1/11 (PDF - 13 KB )
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Page Last Updated: Thursday, 20-Oct-2011 15:39:01 CDT
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