Virtual Colonoscopy Emerges As Turf Battle Between Radiologists, Gastroenterologists

Cheryl Clark, for HealthLeaders Media , June 2, 2010

Some people just don't want to accept the idea of a 6-foot scope being inserted.

Yee says that Medicare's reluctance to approve the scan is not universal, because she says in a few states local Medicare Administrative Contractors will pay for the screening in people 65 and older, but in most other states, MACs will not. "One of the investigators forced the issue in Wisconsin and was able to get approval," she says.

"But maybe there is concern (on the part of Medicare) that they don't want to open the floodgates, with the potential that there would be so many more people who would want screening at a time when there is so much uncertainty about healthcare reform."

She says that Medicare's rationale "doesn't make any sense," especially when considering the cost, which for people paying out-of-pocket, amounts to $800 to $1,000 compared to colonoscopy, which costs $3,000.

John Patti, MD, chair of the ACR Board of Chancellors, said in a statement that the current payment system "creates a two-tiered approach to screening coverage for this deadly and preventable disease: one for those who have private insurance (or the ability to pay out of pocket), and lesser coverage for Medicare beneficiaries."

He added: "It's time for all patients who want a CT colonography to be covered for this lifesaving exam. All the relevant clinical questions have been answered."

One downside, however, is that because CT colonography is less invasive than standard colonoscopy, patients who do have clinically significant polyps will have to have another procedure to have them removed whereas during a colonoscopy, polyps are usually removed during the exam. But Yee says that would only be required in a relatively small number of patients.

Colon cancer causes an estimated 50,000 deaths a year in the U.S. and is said to be one of the most common preventable types of cancer, if it is caught early enough.

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