Despite CMS concerns, virtual colonoscopy use is appropriate

Despite the fact that the Centers for Medicare & Medicaid Services halted reimbursement for computed tomography colonography (CTC) in 2009, partly due to concerns about how the procedure was used in the elderly population, a study of asymptomatic Medicare beneficiaries has determined that CTC--known as virtual colonoscopy--is being used appropriately.

In the study, published online recently in the Journal of General Internal Medicine, researchers from the Perelman School of Medicine at the University of Pennsylvania examined records for 10,538 asymptomatic older patients who underwent CTC from 2007 to 2008. They compared those records to more than 160,000 similar patients who underwent optical colonoscopy. The researchers found that the vast majority of those patients who underwent virtual colonoscopy had incomplete optical colonoscopies, and therefore were appropriate candidates for CTC.

Not only were the individuals appropriate candidates for CTC, almost half of them underwent CTC on the same day as the optical colonoscopy.

"Given that bowel preparation is a strong barrier to screening, offering same day CTC could improve completion of screening by eliminating the need for an additional bowel preparation," lead researcher Hanna Zafar, M.D., an assistant professor of radiology, said according to an announcement. "As such, it is reassuring that CTC following incomplete optical colonoscopy is covered by most insurance companies and CMS."

Of the remaining patients who underwent CTC and had no history of incomplete optical colonoscopy, more than half demonstrated other medically appropriate indications for screening CTC, such as the risk of bleeding or complications from sedation (which is unnecessary with virtual colonoscopy). According to the authors, the data suggests that virtual colonoscopy has been used to expand colorectal cancer screening, instead of just replacing optical colonoscopy.

"Additional research is needed in this important area since approximately 40 to 50 percent of Medicare patients do not undergo any recommended method of colon cancer screening," Zafar said.

To learn more:
- see the study in the Journal of General Internal Medicine
- read the announcement

Related Articles:
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Study: Too many seniors undergoing colonoscopy
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