Virtual colonoscopy, also known as CT colonography, is considered an experimental/investigational procedure. Payment is not made for this procedure. A participating, preferred, or network provider can bill the member for the denied service.
Recently published medical literature provides information on this evolving technology describing promising applications. However, further studies are needed to compare current gold-standard conventional colonoscopy or sigmoidoscopy in low-, average-, and high-risk patient populations. The use of CT colonography in this overall population-based colon cancer screening strategy has not been clearly defined and has not shown to be cost effective in patient outcomes.
The relatively low specificity and sensitivity of virtual colonoscopy in yielding false positive results reduces its cost-effectiveness, because false positives could result in many unnecessary follow-up conventional procedures. There have been no studies evaluating the effectiveness of CT colonography in reducing morbidity or mortality from colorectal cancer. In addition, there is insufficient data to measure the frequency of complications with CT colonography.
The American Cancer Society’s (ACS) Colorectal Cancer Advisory Group concluded that evidence is insufficient to determine whether CT colonography is comparable or superior in performance to conventional colonoscopic evaluations. The ACS suggested further studies are needed before virtual colonoscopy/CT colonography is recommended for routine colorectal cancer screening.
Codes 0066T and 0067T, as appropriate, should be used to report virtual colonoscopy/CT colonography. However, some providers may report CT of the abdomen (codes 74150-74170) in conjunction with 3-dimensional and/or holographic reconstruction (code 76375) to obtain payment. Because CT colonography/virtual colonoscopy is considered investigational, no payment should be made for this procedure under these codes.
Description
CT colonography is often referred to as "virtual colonoscopy." This test involves pumping air into the colon, and performing a special computed tomographic (CT) study called a helical or spiral CT scan. This type of scan takes many thin pictures of the structures in the abdomen. A computer then constructs 2- and 3-dimensional images of the inside of the colon. This helps the provider detect any abnormalities that may require a closer look.
CT colonography/virtual colonoscopy requires the same type of bowel cleansing regimen prior to the study. However, CT colonography is less invasive than conventional colonoscopy. It does not carry the small but real risk of bowel perforation associated with conventional colonoscopy. It can detect larger polyps, but may not be as sensitive at detecting smaller lesions.
In some instances, virtual colonoscopy may yield a “false positive” reading, that is, a suspicious finding that turns out not to be a polyp. Unlike conventional colonoscopy, polyps cannot be removed during a virtual colonoscopy. If a suspicious area is noted, a conventional colonoscopy or other procedure may still be necessary to diagnose and/or treat the patient. | 
