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.
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 a PEG?
PEG stands for percutaneous endoscopic gastrostomy, a procedure in which a flexible feeding tube is placed through the abdominal wall and into the stomach. PEG allows nutrition, fluids and/or medications to be put directly into the stomach, bypassing the mouth and esophagus. This brochure will give you a basic understanding of the procedure-how it is performed, how it can help, and what side effects you might experience.
How is the PEG performed?
Your doctor will use a lighted flexible tube called an endoscope to guide the creation of a small opening through the skin of the upper abdomen and directly into the stomach. This procedure allows the doctor to place and secure a feeding tube into the stomach.
Patients generally receive an intravenous sedative and local anesthesia, and an antibiotic is given by vein prior to the procedure. Patients can usually go home the day of the procedure or the next day.
Who can benefit from a PEG?
Patients who have difficulty swallowing, problems with their appetite or an inability to take adequate nutrition through the mouth can benefit from this procedure.
How should I care for the PEG tube?
A dressing will be placed on the PEG site following the procedure. This dressing is usually removed after one or two days. After that you should clean the site once a day with diluted soap and water and keep the site dry between cleansings. No special dressing or covering is needed.
How are feedings given? Can I still eat and drink?
Specialized liquid nutrition, as well as fluids, can be given through the PEG tube. If the PEG tube is placed because of swallowing difficulty (e.g., after a stroke), there will still be restrictions on oral intake. Although a few PEG patients may continue to eat or drink after the procedure, this is a very important issue to discuss with your physician.
Are there complications from PEG placement?
Complications can occur with the PEG placement. Possible complications include pain at the PEG site, leakage of stomach contents around the tube site and dislodgment or malfunction of the tube. Possible complications include infection of the PEG site, aspiration (inhalation of stomach contents into the lungs), bleeding and perforation (an unwanted hole in the bowel wall). Your doctor can describe symptoms to watch for that could indicate a possible complication.
How long do these tubes last? How are they removed?
PEG tubes can last for months or years. However, because they can break down or become clogged over extended periods of time, they might need to be replaced. Your doctor can easily remove or replace a tube without sedatives or anesthesia, although your doctor might opt to use sedation and endoscopy in some cases. Your doctor will remove the tube using firm traction and will either insert a new tube or let the opening close if no replacement is needed. PEG sites close quickly once the tube is removed, so accidental dislodgment requires immediate attention.