Colonoscopy

Colonoscopy: Screening or Diagnostic?

PREVENTATIVE SCREENING COLONOSCOPY:

1. Patient is asymptomatic (no gastrointestinal symptoms), over the age of 50, has no personal history or family history of GI disease, colon polyps, and/or cancer.
AND
2. The patient has not undergone a colonoscopy within the last ten years.

DIAGNOSTIC/THERAPEUTIC COLONOSCOPY:

Patient has gastrointestinal symptoms, polyps, GI disease, iron deficiency anemia and/or other abnormal tests.

IMPORTANT: Your Insurance Benefits WILL change from a SCREENING colonoscopy to a DIAGNOSTIC colonoscopy if you have gastrointestinal symptoms or personal history of polyps.  This means that these services may be subject to applicable deductible and coinsurance.

Queston:Can the physician change, add or delete my diagnosis so that I can be considered for a preventative colposcopy screening?
Answer:   NO!   The patient encounter is documented as a medical record from the information you have provided already as well as what is obtained during pre-procedure history and assessment.  It is a binding legal document that cannot be changed to facilitate better insurance coverage.  Please understand that strict government and insurance company documentation and coding guidelines prevent a physician from altering a chart or bill for the sole purpose of coverage determination.

 

Question:  What if my insurance company tells me that the doctor can change, add or delete a CPT or diagnosis code?
Answer:  This happens often.  Many times the insurance representative will tell the patient that if the “doctor had coded it as a screening” it would have been covered differently.  However, further questioning of the representative will reveal that the “screening” diagnosis can only be assigned if it applies to the patient.  Remember, many insurance carriers only consider colonoscopy in a patient over the age of 50 with no personal history or family history as well as no gastrointestinal symptoms as a “screening”.

 

If you are told otherwise by your insurance representative, please document the date, name and phone number of the insurance representative.  Next, contact our patient accounts department (540)667-1244, ext. 234) who will perform an audit of the billing and investigate the information given.  Often the outcome results in the insurance company calling the patient back and explaining that the member services representative should never suggest that physicians change their coding to provide better benefit coverage.


Colonoscopy is the visual examination of the large intestine (colon) using a lighted, flexible fiberoptic or video endoscope. The colon begins in the right-lower abdomen and looks like a big question mark as it moves up and around the abdomen, ending in the rectum. It is 5-6 feet long. The colon has a number of functions including withdrawing water from the liquid stool that enters it so that a formed stool is produced.

Colonoscopy is an outpatient exam that is performed with the patient lightly sedated. The procedure provides significant information used to determine with specific treatment will be given. In certain cases, therapy can be administered directly through the endoscope. Serious complications rarely occur from colonoscopy. Your physician can answer any questions the patient has.

Colonoscopy Prep Instructions

 
Since you will be sedated, you will need to arrange for someone to drive you home after the procedure.  If you do not have a driver your procedure will be cancelled.  You cannot go home by cab unless you have a responsible party with you.  Your driver should wait for you in your room to listen to the doctor’s comments.

ALL PATIENTS ARE TO DO THE FOLLOWING:
 

  • Fill out your History and Physical form completely (front only).
  • Do not stop your aspirin or Plavix unless you are specifically told to do so by your physician.
  • Coumadin is typically stopped 5 days prior to the procedure.  Please confirm with your cardiologist or internist that it would be safe to stop this medication for 5 days.  If it is not safe, please call our clinic for further instructions.
  • If you had total joint surgery within the past 3 months, please call our clinic (540) 667-1244 to reschedule procedure.
  • If you are diabetic, you should typically take one-half of your typical nightly dose the night prior.  You should hold your morning insulin and/or diabetes pill(s) on the morning of the procedure.  They can be resumed once you start eating again.
  • If you are on your menstrual period, use a tampon, if possible.

 
PREPARATION


To ensure a successful exam, please follow all instructions carefully. Failure to accurately and completely prepare for your exam may result in the need for an additional procedure and both procedures will be billed to your insurance.

Purchase the following over-the-counter supplies at your local pharmacy: (our office sells:  EZ2go Prep kit which contains: Bisacodyl tablets, Miralax, and Magnesium Citrate- if you would like to purchase a prep kit you can come to our office M-F 8am – 4:30pm and just ask one of our friendly receptionists. Cost for the prep kit is $20)

  • 2 tablets bisacodyl, each containing 5 mg of bisacodyl (Dulcolax® laxative NOT Dulcolax® stool softener)
  • 1-10 oz. bottle Magnesium Citrate. Alternatively, you may use a 0.5 oz. package of powdered magnesium citrate (17 grams) mixed with 10 oz. of water.
  • 1-8.3 oz. bottle Miralax or generic equivalent
  • 64 oz. Gatorade® liquid (NOT red). Regular Gatorade®, Gatorade G2®, Powerade®, PowerAde Zero®  Crystal Light or Pedialyte® are acceptable. Alternatively, you may purchase two 2.12 oz packets of powdered Gatorade® that can be mixed with water to a total volume of 64 oz of liquid.


7 days before your exam:


Discontinue fiber supplements or medications containing iron. This includes multivitamins with iron, Metamucil® and Fibercon®.

3 Days prior to your exam:

Stop eating all high-fiber foods and begin a Low-Fiber Diet. A low fiber diet helps make the cleanout more effective.

Examples of a Low Fiber Diet include:

  • White bread, white rice, pasta, potato without skin, plain crackers
  • Fish, white meat chicken, eggs, peanut butter without nuts
  • Clear beverages (apple juice, white grape juice, Sprite®, sparkling water, Gatorade®)
  • Cooked carrots, cooked green beans, cooked spinach
  • Milk, plain yogurt, cheese
  • Jelly, salt, pepper, sugar

 

Avoid raw fruits or vegetables, whole wheat or high fiber foods, seeds, nuts, popcorn, bran or bulking agents

 

2 days prior to your exam:

  • Continue Low Fiber Diet.
  • Drink at least 8 glasses of water throughout the day.
  • Refrigerate the Gatorade® or Powerade®, if you wish to drink it cold.
  • Stop eating solid foods at 11:45 pm.


THE DAY BEFORE YOUR PROCEDURE (DAY PRIOR TO SCHEDULED COLONOSCOPY):
  
Start a Clear Liquid Diet and At 12 Noon: Take the 2 bisacodyl (Dulcolax®) tablets
 
Examples of a Clear Liquid Diet:

  • No red liquids; No coffee; No alcohol; No dairy products
  • Water: drink at least 8 glasses of water during the day
  • Tea (do not add milk or creamer)
  • Clear broth or bouillon
  • Gatorade®, Pedialyte® or Powerade® (No red)
  • Carbonated and non-carbonated soft drinks (Sprite®, 7-Up®, Gingerale)
  • Strained fruit juices without pulp (apple, white grape, white cranberry)
  • Jell-O®, popsicles, hard candy (No red)


Between 4 and 6 p.m.:

  • Mix 1 bottle of Miralax® (8.3 oz) with 64 oz. of Gatorade® in a large pitcher.
  • Drink 1 - 8 oz. glass of the Miralax®/Gatorade® solution.
  • Continue drinking 1 - 8 oz. glass every 15 minutes thereafter until the mixture is gone.


After 6 pm: Continue clear liquid diet:

Colon Cleansing Tips:

  • Drink adequate amounts of fluid before and after your colon cleansing to prevent dehydration.
  • Chill the Miralax®/Gatorade® solution in the refrigerator. DO NOT add ice to the solution or your drinking glass.
  • Set a timer for every 15 minutes. Drink each 8 - oz. glass of solution quickly to help flush your colon.
  • Stay near a toilet! You will have diarrhea.
  • Even if you are sitting on the toilet, continue to drink the cleansing solution every 15 minutes.
  • Drink all of the solution until it is gone.
  • If you feel nauseated or vomit, rinse your mouth with water, take a 15 to 30-minute break and then continue drinking the Miralax®/Gatorade® solution.
  • You will be uncomfortable until the stool has flushed from your colon (in about 2-4 hours). You may feel chilled.
  • You may suck on a few hard candies (NO red).
  • Alcohol-free baby wipes or Vaseline® may help ease skin irritation.
  • Over-the-counter hydrocortisone creams, hemorrhoid treatments or Tucks may be used if desired.

 

**THE DAY OF YOUR PROCEDURE**

  • Continue clear liquid diet. Do not eat solid foods. (You may take all of your morning medications)

 
4 hours before your procedure:

  • Drink 10 oz. of Magnesium Citrate.
  • FINISH TAKING YOUR MORNING PREP THEN STOP DRINKING ALL CLEAR LIQUIDS
  • Do not take anything by mouth during this time. (No gum, no tobacco products, no hard candies)
  • Allow extra time to travel to your procedure as you may need to stop and use a restroom along the way.

You are ready for the exam, if you followed all instructions and your stool is no longer formed, but clear or yellow liquid. If you are unsure whether your colon is clean, please call the Endoscopy Center (540) 536-8746 before you leave for your appointment.

  • Bring a list of all of your current medications, including any allergy or over-the-counter medications.
  • Bring a photo ID as well as up-to-date insurance information, such as your insurance card and any referral forms that might be required by your insurance company.