Suggest Ways To Manage Hemorrhagic Complications During Virtual Colonoscopy

Posted on Fri, 29 Jul 2016

Question: I am filing a reconsideration appeal with Medicare requesting that my virtual colonoscopy be approved for reimbursement. I am looking for specific objective medical literature that substantiates
that a virtual colonoscopy is an alternative to a manual colonoscopy.

Answered by Dr. Dr.Arnab (4 hours later)

Brief Answer:
if at risk of bleeding during regular colonoscopy then you'd get virtual colonoscopy done

Detailed Answer:
Hello XXXX, Welcome to HCM..

I've gone through your query and understand your concern..

Yes, you're doctor is quite right as if there's any risk (any bleeding disorder, blood thinner etc.) which may put you at risk of bleeding then you should get a Virtual colonoscopy done, it's well mentioned there in the guidelines also and you should've no problem to get approval by your Medicare for the same..

Expenditure varies from hospital to hospital, however it's far less risky compared to a regular colonoscopy..

Since you've requested for Objective Medical Literature in your favor, I'm sharing with you the XXXXXXX College Of Gastroenterology as well as the Stanford Radiology Scheduling Center's article which has clearly stated regarding the insurance coverage..

1. XXXX

2. XXXX

Please go through them and let me know if there're any further queries that I can help you with..

Take Care
Kind Regards

P.S. If you don't have any further queries, then please close and rate it for further references..

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Dr.Arnab (2 hours later)

Dr. Banerjee,

Thank you for the timely response; however, the sources cited actually support Medicare's decision not to reimburse me by stating in both sources that Medicare does not pay for the procedure. Since Medicare did not recognize my doctor's request, the intent of my appeal is cite medical references that state a CT colonoscopy is as effective as the manual procedure.

Here is an example more representative of what is needed from JAMA XXXXXXX 21, 2016, volume 315, number 23:

"There are numerous screening tests to detect early-stage cancer, including ---colonoscopy, CT colonoscopy---. The USPSTF found no head-to-head studies demonstrating that any of these screening strategies are more effective than others---."

Additionally, what would be of help would be the reason(s) " The Center for Medicare and Medicaid Services recently decided to not cover CT colonography for screening for Medicare patients." as stated in reference 2 above. If I knew why the CT screenings are not authorized, I would know what to include in my appeal. After reading the analytical procedure for CT colonoscopy, it is preferable to have an accurate machine perform the test than an infallible human.

Thank you,
XXXXXXX XXXX

Answered by Dr. Dr.Arnab (37 minutes later)

Brief Answer:
these sources have cited in favor of medicare but there are exemptions too.

Detailed Answer:
Welcome Back Mr XXXXXXX

Appreciate your detailed reply in this regard..

Yes I'm aware of the JAMA article..it's true that CTVC is a relatively new procedure and till now there's no active publication on human source study which can compare it head to head with the conventional colonoscopy..in other words , we need a large scale RCT(Randomized Control Trial) to actually establish the effectivity of CTVC against the conventional colonoscopy..

So, all these articles and publications have those points regarding medicare coverage, but as you have already gone through , you must've come across the part stating that, even though it's not recommended for screening purpose of early stage cancer , but still there are several exemptions in this regard, i.e. an incomplete previous colonoscopy, risk of bleeding(as I've already mentioned in the previous reply), risk of perforation of colon in case of a suspected colonic mass, patient not fit to tolerate the anesthesia given during conventional colonoscopy - so try to find out which one is more suitable in your case and simply get the Certification accordingly, I still believe if the certification's concrete the evidence; they can't overrule your point..

Well since I'm practising in XXXXXXX i don't know any inside person from Medicare, so I can't really comment on the fact why they are not authorizing the CT screening (yes, it is a justified question and only an insider or a well known inside connection can answer it accurately)..

Hope this will clear your doubts..let me know if you have any more in this regard..

Take Care
Kind Regards

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Dr.Arnab (3 hours later)

Dr. Banerjee,

My problem is finding a doctor to certify the exception. I did not have a general doctor when I had the colonoscopy performed, so I requested the procedure on my own. My cardiologist at the time refused to ask for an exception and my general doctor who was my doctor after the fact, wrote the request for an exemption referencing it was my idea to have a virtual colonoscopy. Both doctors thought I should have temporarily gone off blood thinning medications. My common sense opinion was not to affect my arterial system by a deviation in medication. It turned out to be valid premise because I got a subdural hematoma when I was taken off blood thinners for later medical procedure.

Do you know of a US doctor, recognized expert on virtual colonoscopies or a virtual colonoscopy advocate/lobbyist who would prepare an exemption for me or provide me the necessary information for an exemption?

Thank you,
XXXXXXX

Answered by Dr. Dr.Arnab (36 minutes later)

Brief Answer:
here's few of them..

Detailed Answer:
Hello Mr XXXXXXX Welcome Back,

Well your past history is well enough to get yourself channeled through the CTVC, but it has to be done by either an experienced PCP or a Gastro-enterologist who'll first go through your case history and then prepare the certifications..I'm afraid that this is not a job of any advocate/lobbyist, and has to be done by the responsible Physician/surgeon(surgical Gastro-enterologist)..

As per your request, i've done some research and found some names for you in Arizona(I believe your communicating from there)..

1. Dr XXXXXXX XXXXXXX (602) 457-1705 , 13065 W McDowell Rd Ste B108
Avondale, AZ 85392

2. Dr XXXXXXX M. XXXXXXX ,(602) 457-1705, Pinnacle Colon and Rectal Surgeons
2222 E Highland Ave Ste 400 XXXXXXX AZ 85016

3. Dr XXXXXXX E. Schultheis , (602) 707-6846 ,
Colon and Rectal Center of Arizona, XXXXXXX AZ, 18275 N 59th Ave # M-178, XXXXXXX AZ 85308

Just contact them for a detailed appointment and I hope after going through your case file, they'll definitely provide you the desired solution in this regard..

Now I don't know them personally but as per the reviews and ratings along with their vast experience I hope either one of them can provide you the needful..

Let me know how it goes..

My Best Regards

Take Care

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Dr.Arnab (10 hours later)

Dr. Banerjee,

Thank you for the collaboration. Your company's fee is well worth the result. Many doctors here in the US are resistant to giving patients any information.
XXXXXXX

Answered by Dr. Dr.Arnab (14 minutes later)

Brief Answer:
pleasure is all mine..

Detailed Answer:
Welcome Back Mr XXXXXXX

I'm glad to know my consultation has helped you with your concern..

Wishing you the very best of health..

We aim to serve the best and it's patients like you who helps us achieving that..

Take Care
Kind Regards

P.S. If you don't have any more queries then please close this discussion and put your ratings and review for future references..

For future reference you can always get in touch with me, below is my direct follow-up link through which you can contact me anytime anywhere, I'll be happy to help -

http://www.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=71041

Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..

Above answer was peer-reviewed by : Dr. Arnab Banerjee