Welcome to our Patient Education page!
Screening or Diagnostic 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.
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FAQS - Frequently Asked Questions
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.
What is capsule endoscopy?
Capsule Endoscopy lets your doctor examine the lining of the middle part of your gastrointestinal tract, which includes the three portions of the small intestine (duodenum, jejunum and ileum). Your doctor will give you a pill-sized video camera for you to swallow. This camera has its own light source and takes pictures of your small intestine as it passes through. These pictures are sent to a small recording device you wear on your body. Your doctor will be able to view these pictures at a later time and might be able to provide you with useful information regarding your small intestine.
Why is capsule endoscopy done?
Capsule endoscopy helps your doctor evaluate the small intestine. This part of the bowel cannot be reached by traditional upper endoscopy or by colonoscopy. The most common reason for doing capsule endoscopy is to search for a cause of bleeding from the small intestine. It may also be useful for detecting polyps, inflammatory bowel disease (Crohn's disease), ulcers and tumors of the small intestine. As is the case with most new diagnostic procedures, not all insurance companies are currently reimbursing for this procedure. You may need to check with your own insurance company to ensure that this is a covered benefit.
How should I prepare for the procedure?
An empty stomach allows for the best and safest examination, so you should have nothing to eat or drink, including water, for approximately twelve hours before the examination. Your doctor will tell you when to start fasting. Tell your doctor in advance about any medications you take including iron, aspirin, bismuth subsalicylate products and other over-the-counter medications. You might need to adjust your usual dose prior to the examination. Discuss any allergies to medications as well as medical conditions, such as swallowing disorders and heart or lung disease. Tell your doctor of the presence of a pacemaker or defibrillator, previous abdominal surgery, or previous history of bowel obstructions, inflammatory bowel disease or adhesions. Your doctor may ask you to do a bowel prep/cleansing prior to the examination.
What can I expect during capsule endoscopy?
Your doctor will prepare you for the examination by applying a sensor device to your abdomen with adhesive sleeves (similar to tape). The pill-sized capsule endoscope is swallowed and passes naturally through your digestive tract while transmitting video images to a data recorder worn on your belt for approximately eight hours. At the end of the procedure you will return to the office and the data recorder is removed so that images of your small bowel can be put on a computer screen for physician review.
Most patients consider the test comfortable. The capsule endoscope is about the size of a large pill. After ingesting the capsule and until it is excreted, you should not be near an MRI device or schedule an MRI examination.
What happens after capsule endoscopy?
You will be able to drink clear liquids after two hours and eat a light meal after four hours following the capsule ingestion, unless your doctor instructs you otherwise. You will have to avoid vigorous physical activity such as running or jumping during the study.
Your doctor generally can tell you the test results within the week following the procedure; however, the results of some tests might take longer.
What are the possible complications of capsule endoscopy?
Although complications can occur, they are generally rare when doctors who are specially trained and experienced in this procedure perform the test. There is a potential for the capsule to be stuck at a narrowed spot in the digestive tract resulting in bowel obstruction. This usually relates to a stricture (narrowing) of the digestive tract from inflammation, prior surgery or tumor. It is important to recognize obstruction early. Signs of obstruction include unusual bloating, abdominal pain, nausea or vomiting. You should call your doctor immediately for any such concerns. Also, if you develop a fever after the test, have trouble swallowing or experience chest pain, tell your doctor immediately. Be careful not to prematurely disconnect the system as this may result in loss of pictures being sent to your recording device.