RSNA: CTC use on the rise in U.S.; getting more reimbursements

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CHICAGO--Diagnostic CT colonoscopy (CTC) is being performed with increasing frequency, and increasingly as a payable service, according to study findings that sought to assess the U.S. trends in utilization and Medicare coverage of CTC, presented Nov. 29 at the annual Radiological Society of North America (RSNA) conference.

“CTC is increasingly accepted as an alternative to conventional optical colonoscopy for screening and diagnosis,” said Richard L. Duszak, Jr., MD, from the University of Tennessee Health Science Center in Memphis “Medicare and private payor reimbursement remains a hurdle for new technologies, like CTC. However, there has been considerable organized advocacy, which has resulted in more nationwide acceptance.”

The researchers identified claims for diagnostic CTC (CPT code 0067T) from the Medicare Physician Supplier Procedure Summary (PSPS) database between 2005 and 2008. They extracted the frequency of billed and denied services, along with interpreting provider specialty and site of service. The researchers also obtained comparative reference procedure measures were obtained for abdominal CT (CPT codes 74150, 74160 and 74170).

“Prior to July 2004, there were no unique codes for CTC, and were reported CT abdomen exam,” explained Duszak. Hence, their study could only evaluate CTC claims, starting in 2005.

Duszak and colleagues found that the annual claims for diagnostic CTC services for Medicare fee-for-service beneficiaries increased from 3,660 to 10,802, an increase of 195 percent over the study period. This increase was a significantly greater increase than abdominal CT exams, which rose from 4,856,987 to 5,264,921—an 8.5 percent increase.

He reported that the denied CTC claims decreased from 70 percent to 43.4 percent, whereas denials increased minimally for abdominal CT from 4.2 percent to 4.4 percent.

Of all 28,048 CTC claims, 92.3 percent were submitted by radiologists, 1 percent by gastroenterologists and 1.3 percent by other specialty groups. (Also, 5.5 percent were undetermined).

Almost half were performed in office settings (49.1 percent) and remainder in outpatient hospital (43.2 percent), inpatient hospital (6.3 percent) and miscellaneous settings (1.4 percent).

Diagnostic CTC is predominantly performed by radiologists, in office and outpatient hospital settings. Since the advent of CPT tracking codes, utilization of diagnostic CTC by Medicare fee-for-service beneficiaries has tripled, growing significantly faster than abdominal CT. Despite perceptions that diagnostic CTC tracking codes are non-payable, most exams are reimbursed, with coverage expanding yearly, setting the stage for continued increases in patient access.