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AMA CPT / ADA CDT Copyright Statement
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CPT
codes, descriptions and other data only are copyright 2004 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.
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Article Text
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What
is CT Colonography?
CT Colonography (virtual colonoscopy) is an
enhanced abdominal CT scan where computer reconstruction allows detailed
longitudinal 3D examination of the bowel for polyps, cancer, or other
disease. Prior to 1/1/2005, this procedure might have been coded through
the use of the code pairs such as “Abdominal CT” (74150) and “CT, Computer
Reconstruction” (76375), or as a nonspecific code (76499, “Unlisted
diagnostic radiographic procedure”) The use of optical colonoscopy codes
(45355-85) are never appropriate for CT Colonography.
CPT Category III codes must be used for CT Colonography
after 1/1/2005
Effective January 1, 2005, the Center for Medicare and Medicaid Services
(CMS) introduced CPT code 0067T as a new Category III code to track the use
of Diagnostic CT Colonography. The parallel code
0066T designates Screening CT Colonography.
Category III codes are temporary codes for emerging technologies. The
creation of these codes does not imply or endorse efficacy, safety, or
applicability to clinical practice. Thus, Category III codes may include
experimental procedures which are never covered by Medicare. However,
Category III codes represent the most specific CPT designation of a
service, and the service should no longer be submitted as combinations of
other codes or as a nonspecific code.
Non-coverage of 0066T (Screening CT Colonography)
Because all services must be coded at the highest level of specificity, CT Colonography for screening purposes must be coded as
0066T. CPT code 0066T is not covered by Medicare. Only designated screening
benefits are covered by Medicare (for example, screening mammography). Such
screening benefits are periodically revised by Congress and are not at the
discretion of CMS or its contractors. CT Colonography
for screening purposes is not a current Medicare service.
Provisional coverage of 0067T (Diagnostic CT Colonography)
Because all services must be coded at the highest level of specificity, CT Colonography for diagnostic purposes must be coded as
0067T. In general, diagnostic services are appropriate when signs and
symptoms of illness are present. At this time, National Heritage Insurance
Company (NHIC) does not consider routine use of CT Colonography
for diagnosis to be an established intervention which is reasonable and
necessary. NHIC considers CT Colonography to be
medically necessary for the treatment of a patient with signs and symptoms
of colon disease when diagnostic optical colonoscopy has failed or is
incomplete due to obstruction, and where the results of CT Colonography are likely to impact further patient
management. Until further guidelines are established by a local or national
coverage determination (LCD or
NCD), other uses of medically necessary diagnostic CT Colonography
may be submitted for review or appeal.
Documentation guideline
Upon request of NHIC, providers may be asked to submit documentation for
the virtual colonoscopy and documentation of a failed colonoscopy.
Documentation of the failed colonoscopy should be available upon request.
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