Colonoscopy is a procedure that enables your physician to examine the lining of the colon (large bowel) for abnormalities by inserting a flexible tube that is about the thickness of your finger into the anus and advancing it slowly into the rectum and colon.
Unless otherwise necessary, your colonoscopy will be performed in our Endoscopy Suite.
What can be expected during colonoscopy?
Colonoscopy is usually well tolerated. There is often a feeling of pressure, bloating, or cramping at times during the procedure. Your doctor will give you medication through a vein to help you relax and better tolerate any discomfort from the procedure. Most patients sleep through the procedure. You will be lying on your side or on your back while the colonoscope is advanced slowly through the large intestine. As the colonoscope is slowly withdrawn, the large intestine is examined. In some cases, passage of the colonoscope through the entire colon to its junction with the small intestine cannot be achieved. The physician will decide if the limited examination is sufficient or if other examinations are necessary.
What if the colonoscopy shows something abnormal?
If your doctor thinks an area of the bowel needs to be evaluated in greater detail, a forceps instrument is passed through the colonoscope to obtain a biopsy ( a sample of the colon lining). This specimen is submitted to the pathology laboratory for analysis. If colonoscopy is being performed to identify sites of bleeding, the areas of bleeding may be controlled through the colonoscope by injecting certain medications or by coagulation (sealing off bleeding vessels with heat treatment). If polyps are found, they are generally removed. None of these additional procedures typically produce pain. Biopsies are taken for many reasons and do not necessarily mean that cancer is suspected.
What are polyps and why are they removed?
Polyps are abnormal growths from the lining of the colon which vary in size from a tiny dot to several inches. The majority of polyps are benign (noncancerous) but the doctor cannot always tell a benign from a malignant (cancerous) polyp by its outer appearance alone. For this reason, removed polyps are sent for tissue analysis. Removal of a colon polyps is an important means of preventing colorectal cancer.
How are polyps removed?
Tiny polyps may be totally destroyed by fulguration (burning), but larger polyps are removed by a technique called snare polypectomy. The physician passes a wire loop (snare) through the colonoscope and severs the attachment of the polyp from the intestinal wall by means of an electrical current. You should feel no pain during the polypectomy. There is a small risk that removing a polyp will cause bleeding or result in a burn to the wall of the colon, which could require emergency surgery.
What happens after colonoscopy?
After colonoscopy, your physician will explain the results to you. If you have been given medications during the procedure you will not be allowed to drive, take a taxi, or ride the bus. A responsible adult must drive and accompany you home from the procedure because of the sedation used during the examination. Even if you feel alert after the procedure, your judgment and reflexes may be impaired by the sedation for the rest of the day, making it unsafe for you to drive or operate any machinery.
You may have some cramping or bloating because of the air introduced into the colon during the examination. This should disappear quickly with passage of flatus (gas). Generally, you should be able to eat after discharge, but your doctor may restrict your diet and activities, especially after polypectomy.
What are the possible complications of colonoscopy?
Colonoscopy and polypectomy are generally safe when performed by physicians who have been specially trained and are experienced in these endoscopic procedures.
One possible complication is a perforation or tear through the bowel wall that could require surgery. Bleeding may occur from the site of biopsy or polypectomy. It is usually minor and stops on its own or can be controlled through the colonoscope. Rarely, blood transfusions or surgery may be required. Other potential risks include a reaction to the sedatives used and complications from heart or lung disease. Localized irritation of the vein where medications were injected may rarely cause a tender lump lasting for several weeks, but this will go away eventually. Applying hot packs or hot moist towels may help relieve discomfort.
Although complications after colonoscopy are uncommon, it is important for you to recognize early signs of any possible complication. Contact your physician who performed the colonoscopy if you notice any of the following symptoms: severe abdominal pain, fever and chills, or rectal bleeding of more than one-half cup. Bleeding can occur several days after polypectomy.
What You Need to Know Under the Affordable Health Care Act
The Affordable Care Act, passed in March 2010, allows for several preventive services, including colorectal cancer screening, to be covered at no cost to the patient. Colonoscopy is one form of colorectal cancer screening.
Colonoscopy patients fall into 3 different categories and strict coding guidelines are used to determine under which category (screening vs. diagnostic) you may fall. These guidelines may exclude those patients with a history of gastrointestinal issues from taking advantage of the procedure at no cost. In cases like these, patients may be required to pay deductibles and co-pays.
Although your primary care physician may refer you for a “screening colonoscopy”, you may not qualify for the “preventive colonoscopy screening” category.
Colonoscopy Categories
- Diagnostic/Therapeutic Colonoscopy – Patient has gastrointestinal symptoms, colon polyps, or gastrointestinal disease requiring evaluation or treatment by colonoscopy (CPT code: 45380).
- Surveillance/High Risk Colonoscopy Screening – Patient is asymptomatic (no present gastrointestinal symptoms) and has a personal history of Crohn’s Disease, Ulcerative Colitis, or a personal or direct relative with colon polyps, and/or colon cancer. Patients in this category are required to undergo colonoscopy surveillance at shortened intervals (usually 2-5 years) and depending on your insurance carrier, this category may be reimbursed as if you were having a diagnostic colonoscopy (CPT code: 45378/G0105).
- Preventive/Average Risk Colonoscopy Screening (Included as part of the Affordable Care Act) – Patient is asymptomatic (no present gastrointestinal symptoms), is 50 years old or older and has no personal history of gastrointestinal disease, colon polyps, and/or cancer. Patients in this category have not undergone a colonoscopy within the last 10 years (CPT code: 45378/G0121).
Because education is an important part of comprehensive medical care, you have been provided with this information to prepare you for this procedure. If you have questions about your need for colonoscopy, alternative tests, the cost of the procedure, methods of billing, or insurance coverage, do not hesitate to speak to your doctor or your doctor’s office staff. Most endoscopists are highly trained specialists and welcome your questions regarding their credentials and training. If you have questions that have not been answered, please discuss them with the endoscopy nurse or your physician before the examination begins.