Understanding Bowel Preparation

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.

Download this article in PDF format
Don't have Adobe Reader? Download it here

Polyps are benign growths within the lining of the large bowel. Most colon cancers develop from colon polyps over a period of several years. Removing colon polyps reduces the risk for colon cancer.

Understanding Bowel Preparation Before Colonoscopy

It is extremely important that your colon be thoroughly cleaned before your colonoscopy. This will let the doctor see any abnormalities, such as colon polyps, during the procedure. Polyps are small growths in the colon that could later turn into cancer. Cleansing the colon before a colonoscopy is called bowel preparation, or "prep." It involves taking medication that causes diarrhea, emptying the colon. The medication is taken by mouth, and comes in liquid or tablet form. You will also need to change what you eat during the day or two before the colonoscopy.

What bowel preparations steps are involved before the colonoscopy?

Your doctor will prescribe the type of bowel prep that is best for you. You will receive specific instructions. In general, here is what you can expect:

  • Your doctor will tell you to change your diet at least one day before your colonoscopy. Usually you will need to limit your diet to clear broth, tea, gelatin desserts, ginger ale, sherbet, and clear fruit juices (the ones you can see through), such as apple juice.
  • You need to avoid gelatin desserts and liquids that are red or purple.
  • It is important to avoid dehydration during bowel prep. Drink more fluids than you usually do.
  • Your doctor will tell you exactly when to stop eating and drinking before your colonoscopy.
  • Follow carefully all the steps your doctor prescribes.
In order for the colonoscopy procedure to be accurate and complete, the colon must be completely clean. Your doctor will tell you to change your diet at least one day before your colonoscopy.

Can I continue to take my current medications?

Tell your doctor what medications you're taking, especially aspirin products, arthritis medications, anticoagulants (blood thinners such as warfarin or heparin), clopidogrel, insulin or iron products. Most medications can be continued. Some can interfere with either the prep or the colonoscopy.

Why is bowel prep important?

Your bowel must be clean so that your doctor can thoroughly examine your colon. Many patients feel that the bowel prep is the most difficult part of a colonoscopy. But it is important that you try your best to fully complete the prep.

What are the types of bowel prep?

Several types of bowel prep medications are available; the two medications used most often in bowel prep are described in the box on this page. Your physician may recommend one of these or other preps which are available. You will need to carefully follow your doctor's instructions about the exact dose and timing of your prep. Some types of prep may be covered by your medical insurance. You'll want to find out if you have any out-of-pocket costs.

What determines the type of prep I get?

Your medical condition is the most important factor in deciding which type of bowel prep is best for you. Tell your doctor if you are pregnant or breast feeding, or if you have a history of bowel obstruction. Let the doctor know if you have high blood pressure. Also, mention if you have any heart, kidney or liver disease, or if you have had any of these diseases in the past. You need to mention any allergies you have to medications to the doctor. If you have had difficulty with a bowel prep in the past, be sure to mention this as well. Other factors in choosing the type of prep are the time of the colonoscopy appointment, individual preferences (taste and amount of medication), and out-of-pocket costs.

Cleaning your colon thoroughly before your colonoscopy allows the doctor to see abnormalities, such as colon polyps, during the procedure. Cleansing the colon involves taking medication that causes diarrhea, emptying the colon.

What if I forget to take the medication when I should, or remember too late to finish the prep?

Call your doctor and ask what to do if you are not able to complete the bowel prep as advised.

What are the common side effects of bowel prep?

The type and severity of side effects differ among patients. They also vary with the product used. Some patients have nausea, vomiting, bloating (swelling in the abdomen) or abdominal pain. A prep can cause kidney failure, heart failure or seizures, but this is rare. Your doctor will explain the possible side effects of the prep selected for you.

Bowel Prep Medications

Polyethylene glycol; Electrolytes oral solution (PEG-based products) may come as a powder to be mixed with water before use. They are available only by prescription and are taken by mouth. Although given in a greater volume than other products used in bowel prep, PEG-based products are often preferred for patients with kidney, heart and liver conditions. The reason is that they do not cause mineral or fluid changes that can lead to dehydration.

Sodium phosphate comes in tablet form to be taken by mouth and requires a prescription. In rare cases, sodium phosphate can cause kidney failure. Doctors consider this when deciding if sodium phosphate is appropriate for a given patient.

Download this article in PDF format
Don't have Adobe Reader? Download it here