Study may fuel more coverage of CT colonoscopies

More medical centers are beginning to offer virtual or CT colonoscopies after a recent study found evidence that CT colonography is approximately as successful as standard colonoscopy in the detection of large polyps.

Some expect that this study from the American College of Radiology and Image Network, and sponsored by the National Cancer Institute, will prompt CMS to begin covering virtual colonoscopies as early as next year.

A decision for National Coverage Determination by CMS for screening CT colonography would likely be followed by most commercial health plans, according to Jennifer B. Meko, MD, Western Region medical director, MedSolutions.

“Many medical specialty societies are recommending that coverage for CT colonography be contingent on this procedure being performed and interpreted by facilities and physicians that have fulfilled specific certification programs and have an ongoing quality assurance program,” Dr. Meko says.

Many health insurers cover CT colonography for diagnostic purposes in patients for whom colonoscopy is indicated but have failed conventional colonoscopy, patients on anticoagulants who cannot have the anticoagulation withheld, and patients with severe medical conditions that preclude conventional colonoscopy, according to Dr. Meko.

In terms of using CT colonography for screening, three of the health insurers who contract with MedSolutions have added coverage for screening CT colonography according to the screening recommendations issued jointly by the American Cancer Society, the American College of Radiology, and the Multi-Society Task Force on Colorectal Cancer in March 2008-“for colorectal cancer screening every five years in average-risk individuals age 50 years and older.”

According to Dr. Meko, the relative advantages of CT colonography include: elimination of the need for sedation and recovery time, fewer polypectomies of clinically insignificant polyps, the potential for evaluation of clinically significant extra-colonic pathology, and lower risk of perforation and other complications that may occur with standard colonoscopy.

Potential disadvantages of CT colonography include: radiation exposure, the need for a separate endoscopic procedure to evaluate positive findings, variations in expertise and quality across facilities, and the downstream costs and risks generated by following up on incidentally found extra-colonic abnormalities which turn out to be clinically irrelevant.

“It is hoped, but unknown, whether CT colonography will encourage more individuals to be screened for colon cancer,” she says. “Currently, only 18% to 50% of American adults report colon cancer screening with any of the recommended methods. Eliminating the need for sedation and not needing to miss a day of work may be powerful incentives to have screening done, but both conventional colonoscopy and CT colonography require full cathartic bowel preparation along with clear liquid diet prior to the procedure, which for many individuals is the most distasteful part of the entire process.”