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Wireless capsule endoscopy (WCE) enables physicians to see areas of the gastrointestinal tract that are not accessible via upper or lower endoscopy, mainly the small bowel. An ingestible capsule carrying a miniature video camera records and transmits images as it moves through the gastrointestinal (GI) tract. The images are stored in sensors worn around the patient’s waist. After eight to twelve hours the patient returns the belt and data recorder to the clinic. The images are then downloaded and the video is evaluated.
WCE has primarily been used to enhance visualization of the small intestine for evaluation of obscure GI bleeding and diseases of the small intestine, such as Crohn’s disease. WCE has also been proposed as a method of evaluating diseases of the esophagus (e.g., chronic gastroesophageal reflux disease and Barrett’s esophagus) and detecting colonic polyps or colon cancer.
Due to the risk of capsule retention, WCE is contraindicated in patients with small bowel strictures. While radiological tests (such as CT scan, CT enterography, MR enterography, or small bowel follow-through) have typically been used to evaluate small bowel patency prior to WCE, another option is a non-radiological device called the PillCam® patency capsule. The patency capsule is an ingestible, solid, biodegradable capsule composed of compressed lactose and 5% barium sulfate. It carries a tracer material that can be detected by a scanning device. This additional procedure is intended to confirm small bowel patency in patients with known or suspected strictures who may, in fact, be successful candidates for WCE.
I. Wireless capsule endoscopy may be considered MEDICALLY NECESSARY AND APPROPRIATE for ANY of the following indications:
II. The use of wireless capsule endoscopy is considered EXPERIMENTAL/INVESTIGATIVE for all other indications, including, but not limited to:
III. Use of the patency capsule prior to wireless capsule endoscopy is considered EXPERIMENTAL/INVESTIGATIVE due to a lack of clinical evidence demonstrating its impact on improved health outcomes.
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CPT® codes copyright American Medical Association® 2022. All rights reserved.
CDT codes copyright American Dental Association® 2022. All rights reserved.