Despite wide regional variations in reimbursement, virtual colonoscopy use has tripled since the introduction of unique Medicare tracking codes, according to a new study, the second in just over a month to report the growth of this controversial procedure.

Claims for diagnostic VC scans for Medicare fee-for-service beneficiaries rose from 3,660 to 10,802 between 2005 and 2008, according to a new paper published in the April issue of the Journal of the American College of Radiology.

Denial rates for the technique, also called computed tomography colonography, also fell. In 2005, about 70 percent of claims were denied. By 2008, that number had fallen to 43 percent. But denial rates varied by region, with Seattle having the most all-year denial rates (65 percent), and Boston the lowest (35 percent) in the nearly dozen regions looked at in the study. However, Seattle saw one of the steepest drops in denials, from 97 percent in 2005 to 44 percent in 2008.
Although lower, the denial rates are still high when compared to an established modality, the researchers said.

"Although a reduction in national denial rates from 70 percent to 43 percent reflects considerable early progress, when contrasted with denial rates of just 4 percent for established technologies such as abdominal CT, opportunities clearly exist for further improvements in patient access through ongoing expansion of coverage," wrote the researchers, led by Dr. Richard Duszak, Jr., a radiologist in Memphis, Tenn.

The study is one of several showing the increasing popularity of CTC technology. An analysis of hospital surveys published last month in the Journal of the American College of Radiology found that the number of U.S. hospitals offering CTC grew by 31 percent in the past few years.

In 2009, the Centers for Medicare and Medicaid Services denied coverage nationwide for screening tests, but reimbursements for diagnostic CTC scans -- ordered in response to signs or symptoms -- are handled regionally.

The technique involves scanning the colon to create 3-D images to search for cancer and other abnormalities. Advocates say it could increase historically low colon cancer screening rates by attracting patients who might be reluctant to undergo a traditional optical colonoscopy, which requires inserting a camera-tipped tube through the colon.

According to the authors, only half of the 40 million patients eligible for colorectal screening tests actually undergo the exams.

"The potential for future and dramatic growth of CTC clearly exists," the researchers write.

But critics contend it is not cost-effective. Part of the problem is that if a polyp is detected during the CTC scan, a colonoscopy usually has to be ordered anyway to remove it. And the scans can pick up extracolonic findings, which might involve costly further testing or treatments, even though the detected abnormality might never pose a problem for the patient.

A July 2010 study estimated that CTCs cost $600,000 to $700,000 more than colonoscopies per 1,000 Medicare-aged patients 65 years old over the course of their lives, provided the scans don't dramatically increase screening compliance rates.

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