Resolved Virtual colonoscopy

[CrystalB_3650]

I was wondering if anyone had billed for the super xl enema system for virtual colonoscopies. If so that hcpcs code would be used because it is for single use only

 

[Lori]

A Virtual colonoscopy, also known as computed tomographic colonography (CTC), is a test used to examine the colon. This test is used for screening (e.g., colorectal cancer [CRC]) and as a diagnostic tool (e.g., colorectal polyps, CRC). It involves the use of helical computed tomography (CT) and computer-generated images to produce high-resolution two- and three-dimensional (3D) images of the colon and rectum. Prior to virtual colonoscopy, standard bowel cleansing preparations are needed to evacuate any stool and fluid from the colon. During the procedure, a rectal tube is inserted and the colon is distended using room air or carbon dioxide and images are then taken by a helical CT scanner. The results are interpreted by a radiologist. If suspicious lesions are detected, the patient generally must undergo further testing via conventional colonoscopy. Magnetic resonance (MR) colonography, also considered virtual colonoscopy, is a diagnostic test generally performed by a radiologist and may be suggested to detect colorectal polyps and CRC. MR colonography imaging involves the use of magnetic resonance imaging (MRI) data to create a 3D image of the interior surface of the colon. The outpatient procedure requires a bowel cleansing preparation.

Virtual colonoscopy using CT (74261-74263)
Virtual colonoscopy using MRI (76498)

CPT® Code - 74263 Computed tomographic (CT) colonography (i.e., virtual colonoscopy), screening, including image postprocessing is never covered.

HCPCS code A4459 Manual pump-operated enema system includes balloon catheter & all accessories reusable any type

I did not find a single use only reusable.

There is also A4458 Enema bag with tubing reusable

Medicare Payment Rules for Items Described by Codes Recently Added to the Healthcare Common Procedure Coding System (HCPCS)

The following codes are added to the HCPCS effective October 1, 2021:

A4453 - Rectal catheter for use with the manual pump-operated enema system, replacement only

In the case of code A4453, this code describes the replacement of an accessory used in conjunction with a manual pump-operated enema system (HCPCS code A4459), which does not fall under an existing Medicare benefit category that would result in separate payment or pricing for the device. As a result, there would be no payment or pricing for replacement of any components or accessories used in conjunction with this device.