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Virtual Colonoscopy Use Triples, What About Medicare?


Convincing people to undergo a colonoscopy has always been a challenge, but in recent years the use of virtual colonscopy has tripled, which is an encouraging sign. Among the hurdles that remain to better utilization of virtual colonoscopy as a screening tool is the lack of coverage by Medicare.

Screening colonoscopy can catch disease early

Screening colonoscopy is an effective tool for early detection of polyps, which are often predecessors of colorectal cancer. Timely identification of polyps and their removal can save lives from colorectal cancer, the second leading cause of cancer death in the United States.

A colonoscopy can be done for both screening and diagnostic purposes, and can be performed one of two ways. One is the conventional optical colonoscopy, which involves inserting a long, lighted, flexible tube called a colonoscope into the colon to view the inside for signs of polyps and other indications of disease.

The other type is virtual colonoscopy (also known as computed tomographic colonography, or CTC), which uses a short, thin tube and computed tomography or magnetic resonance imaging (MRI) to view the inside of the colon. The computer assembles the images to create an animated, three-dimensional view of the large intestine.

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In the new study published in the Journal of the American College of Radiology, the authors evaluated Medicare claims for diagnostic virtual colonoscopy for the years 2005 through 2008 and noted a threefold increase nationwide of virtual colonoscopy and Medicare coverage.

According to lead author Richard Duszak, Jr., MD, the fact that use of virtual colonoscopy has increased to rapidly, “evenin the absence of Medicare coverage for screening CTC, speaks volumes to the need of an alternative exam for those who choose not to undergo colonoscopy.”

Virtual colonoscopy has several advantages over the conventional approach:

  • Virtual colonoscopy uses a thin tube that is inserted into the rectum, whereas the conventional approach requires inserting a colonoscope into the entire length of the colon
  • No sedation is needed
  • Virtual colonoscopy takes less time than the conventional colonoscopy
  • Virtual colonoscopy provides clearer images

Duszak noted that previous studies have shown the two types of colonoscopy to provide “equivalent performance.“ For patients, virtual colonoscopy is less invasive and less uncomfortable, and therefore patients seem more willing to undergo the procedure.

Although screening virtual colonoscopy is a good tool for identifying colorectal cancer, the lack of Medicare coverage is an obstacle. Duszak stated that if Medicare agreed to cover screening virtual colonoscopies, this action “could spark wider access to this potentially life-saving exam and help raise what have traditionally been low colorectal cancer screening rates.”

Duszak R et al. Journal of the American College of Radiology 2011 Apr; 8(4): 235-41