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The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Virtual Colonoscopy (CT Colonography) L33452. Limitations. CPT ® Code - 74263 Computed tomographic (CT) colonography (i.e., virtual colonoscopy), screening, including image postprocessing is never covered.
This article contains coding and other guidelines that complement the Local Coverage Determination (LCD) for Computed Tomographic (CT) Colonography for Diagnostic Uses. Coding Information: Procedure codes may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits.
This article gives guidance for billing, coding, and other guidelines in relation to local coverage policy L34055-Virtual Colonoscopy (CT Colonography). General Guidelines for Claims submitted to Part A or Part B MAC: Procedure codes may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits.
To bill the professional and technical components for the diagnostic CT colonography, in the office setting (POS 11), report 74261 or 74262 on a single claim with no modifiers. It is incorrect coding to report procedure code 74261 or 74262 when performing a screening procedure.
To bill the professional and technical components for the diagnostic CT colonography, in the office setting (POS 11), report 74261 or 74262 on a single claim with no modifiers. It is incorrect coding to report procedure code 74261 or 74262 when performing a screening procedure.
Coverage Indications, Limitations, and/or Medical Necessity. Indications. Computed Tomography (CT) colonography, also known as virtual colonoscopy, utilizes helical CT of the abdomen and pelvis along with 2D or 3D reconstruction to visualize the colon lumen.
CT colonography, also known as virtual colonoscopy utilizes helical computed tomography of the abdomen and pelvis along with 2D or 3D reconstruction to visualize the colon lumen. The test requires colonic preparation similar to that required for instrument (fiberoptic, video) colonoscopy, as well as air insufflation to achieve colonic distention.
CT colonography is indicated when a board certified or board eligible gastroenterologist, a surgeon trained in endoscopy or a physician with equivalent endoscopic training determines from an evaluation of the patient that optical colonoscopy cannot be safely attempted.
CT colonography screening could be cost-effective (i.e., be a non- dominated strategy) at per-test cost of $108 to $205 per scan depending on the simulation model used and the test characteristics of CT colonography.
Quality ID #113 (NQF 0034): Colorectal Cancer Screening. National Quality Strategy Domain: Effective Clinical Care. Meaningful Measure Area: Preventive Care.