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016.06.36-225.200 Computed Tomographic Colonography (CT Colonography)

AR ADC 016.06.36-225.200Arkansas Administrative CodeEffective: February 1, 2022

West's Arkansas Administrative Code
Title 016. Department of Human Services
Division 06. Division of Medical Services
Rule 36. Physician/Independent Lab/Crna/Radiation Therapy Center Provider Manual (Refs & Annos)
Section 224.000. Inpatient Hospital Services.
Effective: February 1, 2022
Ark. Admin. Code 016.06.36-225.200
016.06.36-225.200 Computed Tomographic Colonography (CT Colonography)
Currentness
A. The following procedure codes are covered for CT colonography for beneficiaries of all ages.
View or print the procedure codes for Physician/Independent Lab/CRNA/Radiation Therapy Center services.
B. CT colonography policy and billing
1. Virtual colonoscopy, also known as CT colonography, utilizes helical computed tomography of the abdomen and pelvis to visualize the colon lumen, along with 2D and/or 3D reconstruction. The test requires colonic preparation similar to that required for standard colonoscopy (instrument/fiberoptic colonoscopy) and air insufflation to achieve colonic distention.
2. Indications: Virtual colonoscopy is only indicated in those patients in whom an instrument/fiberoptic colonoscopy of the entire colon is incomplete due to an inability to pass the colonoscopy proximately. Failure to advance the colonoscopy may be secondary to an obstruction neoplasm, spasm, redundant colon, diverticulitis extrinsic compression or aberrant anatomy/scarring from prior surgery. This is intended for use in pre-operative situations when knowledge of the unvisualized colon proximal to the obstruction would be of use to the surgeons in planning the operative approach to the patient.
3. Limitations:
a. Virtual colonography is not reimbursable when used for screening or in the absence of signs or symptoms of disease, regardless of family history or other risk factors for the development of colonic disease.
b. Virtual colonography is not reimbursable when used as an alternative to instrument/fiberoptic colonoscopy, for screening or in the absence of signs or symptoms of disease.
c. Since any colonography with abnormal or suspicious findings would require a subsequent instrument/fiberoptic colonoscopy for diagnosis (e.g. biopsy) or for treatment (e.g. polypectomy), virtual colonography is not reimbursable when used as an alternative to an instrument/fiberoptic colonoscopy, even though performed for signs or symptoms of disease.
d. CT colonography procedure codes are counted against the beneficiary's annual lab and X-ray benefit limit.
e. “Reasonable and necessary” services should only be ordered or performed by qualified personnel.
f. The CT colonography final report should address all structures of the abdomen afforded review in a regular CT of the abdomen and pelvis.
C. Documentation requirements and utilization guidelines
1. Each claim must be submitted with ICD codes that reflect the condition of the patient and indicate the reason(s) for which the service was performed. Claims submitted without ICD codes coded to the highest level of specificity will be denied.
2. The results of an instrument/fiberoptic colonoscopy performed before the virtual colonoscopy (CT colonography) which was incomplete must be retained in the patient's record.
3. The patient's medical record must include the following and be available upon request:
a. The order/prescription from the referring physician
b. Description of polyps/lesion:
i. Lesion size [for lesions 6 mm or larger, the single largest dimension of the polyp (excluding stalk if present) on either multiplanar reconstruction or 3D views. The type of view employed for measurement should be stated];
ii. Location (standardized colonic segmental divisions: rectum, sigmoid colon, descending colon, transverse colon, ascending colon and cecum);
iii. Morphology (sessile-broad-based lesion whose width is greater than its vertical height; pedunculated-polyp with separate stalk; or flat-polyp with vertical height less than 3 mm above surrounding normal colonic mucosa); and
iv. Attenuation (soft-tissue attenuation or fat).
c. Global assessment of the colon (C-RADS categories of colorectal findings):
i. C0 -- Inadequate study
poor prep (can't exclude > 10 lesions)
ii. C1 -- Normal colon or benign lesions
no polyps or polyps ≥5 mm
benign lesions (lipomas, inverted diverticulum)
iii. C2 -- Intermediate polyp(s) or indeterminate lesion
polyps 6 -- 9 mm in size, <3 in number
indeterminate findings
iv. C3 -- Significant polyp(s), possibly advanced adenoma(s)
Polyps ≥10 mm
Polyps 6-9 mm in size, ≥3 in number
v. C4 -- Colonic mass, likely malignant.
d. Extracolonic findings (integral to the interpretation of CT colonography results):
i. E0 -- Inadequate study limited by artifact
ii. E1 -- Normal exam or anatomic variant
iii. E2 -- Clinically unimportant findings (no work-up needed)
iv. E3 -- Likely unimportant findings (may need work-up)
incompletely characterized lesions
e.g., hypodense renal or liver lesion
v. E4 -- Clinically important findings (work-up needed)
e.g., solid renal or liver mass, aortic aneurysm, adenopathy
D. CT colonography is reimbursable only when performed following an instrument/fiberoptic colonoscopy which was incomplete due to obstruction.
E. See Section 292.603 for billing protocol.

Credits

Amended Feb. 1, 2022.
<Editor’s Note: Nonfunctioning links so in original.>
Current with amendments received through February 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 016.06.36-225.200, AR ADC 016.06.36-225.200
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