RSNA: Extra-colonic findings should not deter CTC Medicare reimbursement

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CHICAGO--Recommendations for additional testing or imaging due to extra-colonic findings for Medicare patients should not be a concern for CT colonography (CTC) reimbursement, according to a study presented Nov. 29 at the annual Radiological Society of North America (RSNA) conference.

Extra-colonic findings have been cited by the Centers for Medicare & Medicaid Services (CMS) as a reason to withhold reimbursement for CTC for colon cancer screening. As a result, Gregory Nevsky, MD, and colleagues from New York University Medical Center in New York City, undertook a study to evaluate the frequency of recommendations for additional imaging (RAI) among a cohort of Medicare and non-Medicare aged individuals undergoing CTC.

From 2005 to 2008, 454 subjects underwent supine and prone CTC at an outpatient facility using a 16-slice and 128-slice multidetector CT scanner. In the study, 204 were non-Medicare age (mean age 52) and 250 were Medicare eligible (mean age 69).

The indication for CTC in the non-Medicare group was screening 112 patients, and incomplete colonoscopy (92 patients), according to Nevsky.  The indication for CTC in the Medicare group was screening 82 patients, and incomplete colonoscopy (168 patients).

Cases were prospectively reported by one of four abdominal radiologists with experience in CTC. The dictated reports were retrospectively analyzed to determine the frequency of reported extra-colonic findings and the number of times RAI was reported. Fisher’s exact test was used to compare the percentage of Medicare and non-Medicare patients with at least one extra-colonic finding as well as the frequency of RAI. The researchers stratified results according to whether the patients were being evaluated for screening or incomplete colonoscopy.

They found that the percentage of patients with at least one extra-colonic finding was 55.4 percent for the non-Medicare group and 74 percent for Medicare patients. The percentage of times an extra-colonic finding was reported was significantly higher (p <0.0001) among Medicare patients than among non-Medicare patients.

Nevsky reported that the percentage of patients for which RAI was suggested was 4.4 percent for non-Medicare and 6 percent for Medicare patients, which was “not statistically different.”

Among the subjects in the Medicare and non-Medicare groups, the clinical indication for CTC was not seen to have a significant influence on the likelihood of an extra-colonic finding being detected (p=0.769) or RAI being suggested (p=0.520).

He acknowledged that a limitation of the study was that it was retrospective, as opposed to prospective. Also, due to the fact that the study took place in an outpatient center, the actual outcomes with the patients were not known.

“Among a group of trained abdominal radiologists the frequency of RAI at CTC is exceedingly low among both Medicare and non Medicare patients and is not influenced by the clinical indication of the study,” the authors concluded.