Understanding Colonoscopy

Welcome to our Patient Education page!

Our team of specialists and staff strive to improve the overall health of our patients by focusing on preventing, diagnosing and treating conditions associated with your digestive system. Please use the search field below to browse our website. You'll find a wide array of information about our office, your digestive health, and treatments available. If you have questions or need to schedule an appointment, contact our office.

Screening or Diagnostic Colonoscopy?

All colonoscopies, whether diagnostic or screening, are billed under the CPT/Procedure code 45378.  The diagnosis or reason for the colonoscopy is what determines if the procedure is diagnostic/surveillance or preventative/screening. 
 

Diagnostic/Surveillance Colonoscopy: 

The patient has past and/or present gastrointestinal symptoms, polyps, GI disease, iron deficiency anemia and/or any other abnormal tests OR the patient is currently asymptomatic (no gastrointestinal symptoms either past or present) but has a personal history of GI disease, personal and/or family history of colon polyps and/or colon cancer.  Patients in this category are required to undergo colonoscopy surveillance at shortened intervals (e.g. every 2-5 years). 

Insurance plans process these claims subject to the individuals deductible and co-insurance requirements.

Preventative Screening Colonoscopy:

The patient is asymptomatic (no gastrointestinal symptoms either past or present), age 50 or greater, has no personal or family history of GI disease, colon polyps, and/or cancer.  The patient has not undergone a colonoscopy within the last 10 years.

Insurance plans usually process these claims under the wellness benefit, payable at 100% if it is a benefit of the individual’s health insurance plan.

Frequently asked questions:

Who will bill me?

You may receive bills for your procedure from the physician, the facility, anesthesia, pathologist and/or laboratory. 

Can the physician change, add, or delete my diagnosis so that my procedure can be considered a preventative/wellness/routine screening?

NO!  The patient encounter is documented as a medical record from the information you have provided, as well as what is obtained during our pre-procedure history and assessment.  It is a binding legal document that cannot be changed to facilitate better insurance coverage.

What if my insurance company tells me that the doctor can change, add or delete a CPT or diagnosis code?

This happens a lot. Often the representative will tell the patient that if the “doctor had coded this as a screening, it would be paid at 100%."  A member services representative should never suggest a physician alter a medical record for billing purposes. 


FAQS - Frequently Asked Questions

Q: How long will my procedure take?
A: Plan to spend 2- 2 1/2 hours with us from the time you arrive until when you are released to go home. The procedures themselves are relatively quick.
- An upper endoscopy takes 8-10 minutes, depending on what is found and the need for biopsies.
- A colonoscopy usually takes about 20-25 minutes, again depending on the findings and need for polyp removal, biopsies, etc.
The rest of your stay involves going over the consent prior to the procedure, a physical assessment, taking vital signs, placing an IV and attaching you to a continuous monitor. After the procedure, you will stay under our observation until you are deemed ready to be driven home.
 
Q: Can I drive myself home after the procedure?
A: No. The anesthesia and sedation we use, while relatively short-acting, can have subtle effects for hours after your procedure. Possible drowsiness and delayed reaction times make driving potentially dangerous. Therefore, having someone drive you home is necessary. You may drive and return to normal activities the following day.
 
Q: How soon can I eat and drink after my procedure?
A: Usually immediately after you leave the office, unless you are told otherwise. It is best to avoid heavy meals for that day.
 
Q: Can I take routine medications the day of the procedure?
A: Please do not take any of your medications except those for blood pressure, heart and seizures unless otherwise instructed by your physician.
 
Q: Do I need antibiotics prior to my procedure for an artificial joint?
A: No. The American Society for Gastrointestinal Endoscopy has concluded that antibiotic use for a patient with an artificial joint is not necessary.
 
Q: What happens if I begin to vomit during my prep?
A: Wait 1-2 hours to allow your stomach to settle. Start to drink the solution at a slower pace- every 20-30 minutes. This will take longer but should keep you from vomiting the rest of the solution.
 
Q: I have my period. Can I still have my colonoscopy?
A: Yes. This will not interfere with your procedure. You may use a tampon during the procedure.
 
Q: Do I have to drink all of my prep?
A: Yes. You want your colon completely cleaned out. This allows the physician to find and treat the smallest and flattest polyps.
 
Q: I’m diabetic. What precautions should I take?
A: If you are diabetic, we will give you special instructions. You will need to let us know ALL of your medications and doses. You should check your blood sugars periodically throughout the day of the prep and the procedure. Since you are on clear liquids, your blood sugar will tend to drop faster than normal. To avoid this, be sure to include some liquids with sugar.
 
Q: What if I forget to stop my blood thinners?
A: Please contact the office.
 
Q: Can I take over the counter medications with my prep?
A: Most over the counter medications are acceptable except fish oil, aspirin, Motrin, Advil, ibuprofen, Aleve, naprosyn, naproxen or iron supplements. Tylenol will not interfere with your procedure.
 
Q: Is it OK to drink alcohol?
A: NO! We strongly suggest that you avoid all alcohol before your procedure as it can cause dehydration and may thin your blood.
 
Q: Can I brush my teeth?
A: Yes.
 
Q: Can I chew gum or suck on hard candy?
A: Yes, but no red candy or candy with soft centers. Nothing after midnight.
 
Q: What can I take for a headache?
A: Tylenol or Extra-Strength Tylenol only.

This information was developed by the Publications Committee of the American Society for Gastrointestinal Endoscopy (ASGE). For more information about ASGE, visit www.asge.org.

This information is intended only to provide general guidance. It does not provide definitive medical advice. It is important that you consult your doctor about your specific condition.

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In a colonoscopy, the physician passes the endoscope through your rectum and into the colon to examine the tissue of the colon wall for abnormalities such as polyps.

What is a colonoscopy?

Colonoscopy lets your doctor examine the lining of your large intestine (colon) for abnormalities by inserting a thin flexible tube, as thick as your finger, into your anus and slowly advancing it into the rectum and colon. This instrument, called a colonoscope, has its own lens and light source and it allows your doctor to view images on a video monitor.


Why is colonoscopy recommended?

Colonoscopy may be recommended as a screening test for colorectal cancer. Colorectal cancer is the third leading cause of cancer deaths in the United States. Annually, approximately 150,000 new cases of colorectal cancer are diagnosed in the United States and 50,000 people die from the disease. It has been estimated that increased awareness and screening would save at least 30,000 lives each year. Colonoscopy may also be recommended by your doctor to evaluate for symptoms such as bleeding and chronic diarrhea.


The endoscope is a thin, flexible tube with a camera and a light on the end of it. During the procedure, images of the colon wall are simultaneously viewed on a monitor.

What preparations are required?

Your doctor will tell you what dietary restrictions to follow and what cleansing routine to use. In general, the preparation consists of limiting your diet to clear liquids the day before and consuming either a large volume of a special cleansing solution or special oral laxatives. The colon must be completely clean for the procedure to be accurate and comprehensive, so be sure to follow your doctor's instructions carefully.

Can I take my current medications?

Most medications can be continued as usual, but some medications can interfere with the preparation or the examination. Inform your doctor about medications you're taking, particularly aspirin products, arthritis medications, anticoagulants (blood thinners such as warfarin or heparin), clopidogrel, insulin or iron products. Also, be sure to mention allergies you have to medications.

What happens during colonoscopy?

A colonoscope is a medical device used by expert physicians to look inside the colon and rectum. The expert physician controls the movement of the flexible tube using the endoscope handle.

Colonoscopy is well-tolerated and rarely causes much pain. You might feel pressure, bloating or cramping during the procedure. Typically, your doctor will give you a sedative or painkiller to help you relax and better tolerate any discomfort. You will lie on your side or back while your doctor slowly advances a colonoscope along your large intestine to examine the lining. Your doctor will examine the lining again as he or she slowly withdraws the colonoscope. The procedure itself usually takes less than 45 minutes, although you should plan on two to three hours for waiting, preparation and recovery. In some cases, the doctor cannot pass the colonoscope through the entire colon to where it meets the small intestine. Your doctor will advise you whether any additional testing is necessary.

What if the colonoscopy shows something abnormal?

If your doctor thinks an area needs further evaluation, he or she might pass an instrument through the colonoscope to obtain a biopsy (a small sample of the colon lining) to be analyzed. Biopsies are used to identify many conditions, and your doctor will often take a biopsy even if he or she doesn't suspect cancer. If colonoscopy is being performed to identify sites of bleeding, your doctor might control the bleeding through the colonoscope by injecting medications or by cauterization (sealing off bleeding vessels with heat treatment) or by use of small clips. Your doctor might also find polyps during colonoscopy, and he or she will most likely remove them during the examination. These procedures don't usually cause any pain.

Polyps are abnormal growths in the colon lining that are usually benign (noncancerous). They vary in size from a tiny dot to several inches.

What are polyps and why are they removed?

Polyps are abnormal growths in the colon lining that are usually benign (noncancerous). They vary in size from a tiny dot to several inches. Your doctor can't always tell a benign polyp from a malignant (cancerous) polyp by its outer appearance, so he or she will usually remove polyps for analysis. Because cancer begins in polyps, removing them is an important means of preventing colorectal cancer.

How are polyps removed?

Your doctor may destroy tiny polyps by fulguration (burning) or by removing them with wire loops called snares or with biopsy instruments. Your doctor will use a technique called "snare polypectomy" to remove larger polyps. Your doctor will pass a wire loop through the colonoscope and remove the polyp from the intestinal wall using an electrical current. You should feel no pain during the polypectomy.

What happens after a colonoscopy?

You will be monitored until most of the effects of the sedatives have worn off. You might have some cramping or bloating because of the air introduced into the colon during the examination. This should disappear quickly when you pass gas. Your physician will explain the results of the examination to you, although you'll probably have to wait for the results of any biopsies performed. If you have been given sedatives during the procedure, someone must drive you home and stay with you. Even if you feel alert after the procedure, your judgment and reflexes could be impaired for the rest of the day. You should be able to eat after the examination, but your doctor might restrict your diet and activities, especially after polypectomy. Your doctor will advise you on this.

What are the possible complications of colonoscopy?

Colonoscopy and polypectomy are generally safe when performed by doctors who have been specially trained and are experienced in these procedures. One possible complication is a perforation, or tear, through the bowel wall that could require surgery. Bleeding might occur at the site of biopsy or polypectomy, but it's usually minor. Bleeding can stop on its own or be controlled through the colonoscope; it rarely requires follow-up treatment. Some patients might have a reaction to the sedatives or complications from heart or lung disease. Although complications after colonoscopy are uncommon, it's important to recognize early signs of possible complications. Contact your doctor if you notice severe abdominal pain, fever and chills, or rectal bleeding. Note that bleeding can occur several days after the procedure.

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