Colonoscopy
Dr. Deirdre Hart, elective colon and rectal surgeon, discusses colonoscopy.
Screening Colonoscopy Versus Diagnostic Colonoscopy
Screening Colonoscopy
Patient is over 45 and asymptomatic with no GI issues to report.
- No pathology found to report. IF screening colonoscopy is a benefit, insurance should consider it as a covered benefit.
- If pathology is found and reported, a modifier is added to the claim to demonstrate it was a screening procedure that changed to a diagnostic one, which changes patient responsibility for payment.
Diagnostic Colonoscopy
Patient of any age with any GI symptoms or a positive Cologuard or fecal occult test.
- GI symptoms disqualify any colonoscopy from being a “screening” procedure, even if it is the first procedure a patient has had or they are due for repeat. Examples include diverticulitis, rectal bleeding, abdominal pain, abnormal imaging, etc.
- Most insurance companies consider Cologuard to be the primary colon cancer screening test if done first. If test result is positive, colonoscopy can only be diagnostic.
- Colonoscopy may be a covered benefit, but diagnostic colonoscopy is not considered “screening” or preventative care.
Frequently Asked Questions
One of the big reasons to get your colonoscopy is that colon cancers are asymptomatic. You don't know you have one until it has progressed to the point that you're either bleeding or obstructed and not passing things through anymore. With the colonoscopy, we want to find that either before it becomes a cancer or as early as possible in its development.
The day before we have you drink a combination of Miralax and Gatorade, and it cleans out your colon and cleans out your system so that we can get the best look at your colonic tissue as possible.
The day of your colonoscopy you come in, get an anesthetic to put you to sleep, which usually takes about thirty minutes, and then you wake up and go home the same day.
Depending on your race, family history, other diseases you may have, you might need a colonoscopy earlier, so that's something to talk to your primary care doctor about. When you need your next colonoscopy depends on the findings of the first colonoscopy.
If your colonoscopy is normal, the recommendation is 10 years, again based on family history and findings of other colonoscopies.
If during your colonoscopy we see polyps or other lesions that we're concerned about, we can biopsy them at the time of your colonoscopy. We send them to the pathologist, and they tell us what it is. Then, we base your next colonoscopy on that.
On your colonoscopy we may find just normal colonic mucosa. We may find diverticulosis or diverticulum, which is a normal finding in many people. We can find polyps or precancerous growths and remove them at that time. And the real reason you want to get your colonoscopy is to remove the polyps before they would become a cancer. This is another thing we can find on colonoscopy and then plan further treatment from there.
A polyp is a precancerous growth. They can vary in size from a couple millimeters to several centimeters. Most colon cancers start from polyps, so we want to do the colonoscopy and remove those polyps before they have a chance to develop into a colon cancer.