Endoscopy

Obtaining bowel preparation for endoscopy screening 

The bowel preparation may be obtained from the office of the primary health care provider (e.g. GP), from endoscopy units or other screening facilities, or from pharmacists. There is no evidence concerning the impact of any of these strategies on participation rate, or on the proportion of inadequate exams. The aim should be to maximise accessibility taking into account local conditions, setting and culture. Several providers close to the target population should be available

Bowel preparation for sigmoidoscopy 

The acceptability of different types of preparations is influenced by cultural factors, which should be considered together with the evidence concerning the effect of the preparation, when choosing among different options. No difference in the proportion of inadequate exams was observed when comparing a single enema regimen to a preparation using two enemas or to oral preparation

Summary of evidence 

 A bowel preparation regimen using a single enema self-administered at home two hours before the endoscopy has been reported as the most acceptable option (II). 

 Using two enemas may not decrease participation, while a preparation using both oral preparation and enema has a negative effect on compliance (II). 

Bowel preparation for colonoscopy 

Data on the impact of different preparation regimens in the context of population screening with colonoscopy are lacking. A recent systematic review (Belsey, Epstein & Heresbach 2007) concluded that no single bowel preparation emerged as consistently superior, but sodium phosphate was better tolerated.

Timing of administration of the recommended dose appears important, as it has been established that split dosing (the administration of at least a portion of the laxative on the morning of the examination) is superior to dosing all the preparation the day before the test, both for sodium-phosphate and polyethylene glycol (Aoun et al. 2005; Parra-Blanco et al. 2006; Rostom et al. 2006; Cohen 2010) (II)

Summary of evidence 

 To date no single bowel preparation for colonoscopy has emerged as consistently superior over another in terms of efficacy and safety (I) although sodium phosphate may be better tolerated and it has been shown that better results are obtained when the bowel preparation is administered in two steps (the evening before and on the morning of the procedure) (II).  

Test interpretation and reporting  

Inadequate test 

An operational definition for an inadequate screening test should be made explicit in the programme protocol, taking into account the characteristics of the test as well as the testing procedure adopted . 

Defining a negative test and episode result 

An explicit protocol defining the conditions for classifying a test as negative should be adopted, specifying the criteria for referral to colonoscopy assessment (in FS-based programmes) or surveillance (TC-based programmes).

Also, an operational definition for a negative screening episode should be made explicit in the programme protocol. A screening episode should be classified as negative when, based on the results of the primary test or of the recommended assessments (if any), the subject is referred again to the standard screening protocol. The rationale for having such pragmatic definition is to avoid the risk of labelling people detected with lesions that do not have clinical and prognostic significance

General points to remember

Please Note:

1. If you are a diabetic and receiving oral diabetic agents, please do not take these medications the day before and the day of your procedure. 

2. If you are diabetic and receiving insulin, please discuss this with our office at least seven (7) days prior to your colonoscopy/endoscopy. 

3. If you are taking Coumadin (warfarin), please discuss this with our office at least seven (7) days prior to your colonoscopy/endoscopy. 

4. If you are taking steroid medications (e.g. Prednisone, Decadron, Medrol), please discuss this with our office at least seven (7) days prior to your colonoscopy/endoscopy. 

5. If you have had a cardiac valve replacement or a history of endocarditis (infection or inflammation of a heart valve generally requiring prolonged intravenous antibiotic therapy), please discuss this with our office at least seven (7) days prior to your colonoscopy/endoscopy. 

6. Do not take the following medications for a period of seven (7) days prior to your colonoscopy/endoscopy: aspirin or aspirin-containing medications (e.g. Anacin, Bufferin, Alka-Seltzer), and iron (including multivitamins that contain iron). 

7. Do not take nonsteroidal anti-inflammatory drugs (NSAID’s, e.g., Motrin, Advil, Nuprin, Naprosyn, Voltaren, Vioxx, Celebrex, and others)for a period of three (3) days prior to your colonoscopy/endoscopy. 

8. All other medications including antiplatelet drugs [e.g. Plavix (clopidogrel), Ticlid (ticlopidine), Pletal (cilostazol)] may be continued without change and may be taken up to and including the day of your colonoscopy/endoscopy.

9. If you have a history of congestive heart failure, liver disease or kidney disease, please discuss your preparation instructions with our office at least seven (7) days prior to your colonoscopy/endoscopy. 

10. Since you will be given a sedative for this examination, you must have a responsible adult take you home and accompany you into your residence. As well, you must have a responsible adult stay with you for the next 24 hours. You should plan on limiting your activity and resting at home for the remainder of the day. You must not drive a motor vehicle or operate machinery for the next 24 hours. If there is a problem with these arrangements, please inform this office to allow for rescheduling of your procedure. Sedation for your procedure cannot be administered unless these arrangements are completed. 

11. If you have an insurance plan that requires a referral (MVP, CDPHP, Senior Blue, many others), please be sure our office has a referral from your primary care physician to cover this procedure. If your insurance requires pre-authorization, please be sure our office has obtained this

Endoscopy

We perform colonoscopy and upper GI endoscopy at Glens Falls Hospital, Saratoga Hospital, and Northern GI Endoscopy located at Five Irongate Center, Glens Falls. Please read the following instructions pertaining to the appropriate location of your procedure

Glens Falls Hospital: The Glens Falls scheduling staff will be calling to pre-register you. If you have not been contacted within 10 days of your scheduled appointment please call 926-5327. You will need to complete the Glens Falls Hospital Pre-Admission History and Physical form and bring it with you to the GI Center on the day of your procedure. You can print out this form by going into patient forms and click on Glens Falls Hospital Admission History and Physical. On the day of your exam, please report directly to the GI Center 45 minutes prior to the time of your exam, located past the emergency room entrance on the left (east) side of the hospital around to the back of the hospital. The parking lot for the GI Center is located on the back (south) side of the hospital immediately adjacent to the entrance of the GI Center. 

Saratoga Hospital: Please call the Registration Desk at 587-3222 on any weekday before your scheduled exam to pre-register. On the day of your exam, please report directly to the 2nd floor Day Surgery/Endoscopy area one hour prior to your appointment. Enter to the right side of the hospital (ground level, Same Day Surgery, Ambulatory entrance). 

Northern GI Endoscopy: You will be contacted by a staff member of Northern G.I. Endoscopy prior to your procedure to confirm your appointment and answer any questions that you may have. You will need to complete the Northern GI Endoscopy Pre-Admission History form and bring it with you to Northern GI Endoscopy on the day of your procedure. You can print out this form by going into patient forms and click on Northern GI Endoscopy Pre-Admission History Form. On the day of your exam, please report to Northern G.I. Endoscopy, located directly behind our office at 5 Irongate Center in Glens Falls, one hour prior to the time of your exam. There are designated parking spaces for Northern GI patients along the side of the building, near the Pine Street entrance.

General points to remember

The hospital cannot accept any responsibility for the loss or damage to personal property during your time on these premises. 

If you have any problems with a persistent sore throat, chest or abdominal pain or bleeding please contact your GP immediately informing them that you have had an endoscopy.

If you are unable to contact or speak to your doctor, you must go immediately to the casualty department. If your symptoms persist or worsen, go immediately to casualty. 

It is our aim for you to be seen and investigated as soon as possible after your arrival. However, the department is very busy and your investigation may be delayed. If emergencies occur, these patients will obviously be given priority over less urgent cases.

The hospital cannot except any responsibility for the loss or damage to personal property during your time on these premises.

Dietary instructions for colonoscopy preparation

Low fibre diet 

Fibre is the indigestible part of cereals, fruit and vegetables. Please commence a low fibre diet 2 days before your procedure. 

Foods allowed 

Lean, tender lamb, beef, pork, chicken, turkey, offal, bacon, lean ham, fish, Yorkshire pudding, pancakes; bread sauce; clear and puréed soups; potato (no skins), boiled and mashed; tomato pulp (no skins or pips); fruit juice (if tolerated); pastry made with white flour, white bread, white flour, cornflakes, rice krispies, icing smooth biscuits, eg: Marie, Osborne; spaghetti and pasta; white rice, crisps; rosehip syrup, Ribena; sugar or glucose in small amounts; boiled sweets, toffees; plain or milk chocolate; shortcake, cream crackers, water biscuits; sponge cake, Madeira cake; ice cream, iced lollies; plain or flavoured yoghurt; jelly marmalade; honey, syrup; tea and coffee (without milk) and fizzy drinks. 

Foods to be avoided 

Wholemeal, wheatmeal, granary bread, wholemeal flour; bran biscuits, coconut biscuits; all cereals containing bran or whole wheat, eg; shredded wheat, bran flakes, bran buds, muesli; digestive biscuits; Ryvita, Vita Wheat, oat cakes, etc. 

To enable a more effective examination, we would be grateful if you would take a clear fluid only diet for the period of time stated on the attached appointment letter.

Fluids allowed 

Twenty-four hours before your examination you should take clear fluids only (no food): 

Tea (no milk), black coffee, water, strained fruit juice, strained tomato juice, fruit squash, soda water, tonic water, lemonade, oxo, Bovril, marmite (mixed into weak drinks with hot water), clear soups and broths, consommé.

 In addition 

You may eat clear jellies You may suck clear boiled sweets and clear mints. You may add sugar or glucose to your drinks. 

Fluids not allowed 

Drinks or soups thickened with flour or other thickening agents

Polypectomy

Additional information 

Occasionally polyps are found during the procedure. 

What Are Polyps? 

A polyp is a protrusion from the lining of the bowel, some polyps are pedunculated (look like a mushroom) and are attached to the intestinal wall by a stalk and some are flat polyps which attach directly onto the intestinal wall without a stalk. Polyps when found are generally removed or sampled by the endoscopist as they may grow and cause problems.

Polypectomy 

A polyp may be removed in one of two ways both using an electric current (diathermy). 

For large polyps a snare (wire loop) is placed around the polyp, a high frequency current is then applied and the polyp is removed. 

Flat polyps (without any stalk) can be removed by a procedure called EMR (Endoscopic Mucosal Resection). This involves injecting the lining of the bowel that surrounds the flat polyp. This raises the area and allows the wire loop snare to capture the polyp. 

For smaller polyps biopsy forceps (cupped forceps) are used. These hold the polyp whilst diathermy is applied, therefore destroying the polyp.

After the procedures

You will be allowed to rest for as long as is necessary. Your blood pressure and heart rate will be recorded and if you are diabetic, your blood glucose will be monitored. Should you have underlying difficulties or if your oxygen levels were low during the procedure, we will continue to monitor your breathing and can administer additional oxygen. Once you have recovered from the initial effects of any sedation (which normally takes 30 minutes) you will be offered a snack and moved into a comfortable chair.

Before you leave the department, the nurse or doctor will explain the findings and any medication or further investigations required. She or he will also inform you if you require further appointments. 

Since sedation can make you forgetful it is a good idea to have a member of your family or friend with you when you are given this information although there will be a short written report given to you. 

If you have had sedation you may feel fully alert following the investigation, but however the drug remains in your blood system for about 24 hours and you can intermittently feel drowsy with lapses of memory. If you live alone, try and arrange for someone to stay with you, or if possible, arrange to stay with your family or a friend for at least 4 hours.

 If the person collecting you leaves the department, the nursing staff will telephone them when you are ready for discharge.

Risks of the procedures

Upper gastrointestinal endoscopy and lower gastrointestinal endoscopy are classified as invasive investigations and because of that it has the possibility of associated complications. These occur extremely infrequently, we would wish to draw your attention to them. 

The doctor who has requested these tests will have considered this carefully The risks must be compared to the benefits of having the procedure carried out. 

The risks can be associated with the procedure itself and with the administration of the sedation.

The endoscopic procedure. 

Gastroscopy 

The main risks are of mechanical damage; 

● to teeth or bridgework 

● perforation or tear of the linings of the stomach or oesophagus which could entail you being admitted to hospital. Although perforation generally requires surgery to repair the hole. Certain cases may be treated conservatively with antibiotics and intravenous fluids. 

● bleeding may occur at the site of biopsy and nearly always stops on its own. 

Colonoscopy 

● bleeding (risk approximately 1: 100-200) may occur at the site of biopsy or polyp removal. Typically minor in degree, such bleeding may either simply stop on its own or if it does not, be controlled by cauterization or injection treatment. 

● Perforation (risk approximately 1 for every 1,000 examinations) or tear of the lining of the bowel. An operation is nearly always required to repair the hole. The risk of perforation is higher with polyp removal.

Sedation 

Sedation can occasionally cause problems with breathing, heart rate and blood pressure. If any of these problems do occur, they are normally short lived. Careful monitoring by a fully trained endoscopy nurse ensures that any potential problems can be identified and treated rapidly. 

Older patients and those who have significant health problems – for example, people with breathing difficulties due to a bad chest may be assessed by the doctor before being treated.

Coding Faqs - Screening Colonoscopy Questions

1. How do I bill for a patient seen in our office prior to a screening colonoscopy with no GI symptoms and who is otherwise healthy? 
   
   A visit prior to a screening colonoscopy for a healthy patient is not billable. 
   
   
2. If a patient is referred to our office for a screening colonoscopy and the patient is on Coumadin, can we bill for the visit? 
   
   Yes. If the patient requires some intervention on the part of the gastroenterologist prior to the procedure, you can bill a New Patient or Established Patient visit, depending on whether the patient has received any face-to-face service by any provider of the same specialty in your office within the last three years. 
   
   
3. If a patient is scheduled for a screening colonoscopy and because of a poor prep the scope cannot be advanced beyond the splenic flexure, do I code the procedure as a flexible sigmoidoscopy? 

Anesthesia services - Gastrointestinal endoscopy - CPT 00740 , 00810

 Use of Anesthesia Services for Routine Gastrointestinal Endoscopy

As a general rule, benefits are payable under Blue Cross and Blue Shield of Alabama health plans only in cases of medical necessity and only if services or supplies are not investigational, provided the customer group contracts have such coverage.

The following Association Technology Evaluation Criteria must be met for a service/supply to be

considered for coverage:

1. The technology must have final approval from the appropriate government regulatory bodies;

2. The scientific evidence must permit conclusions concerning the effect of the technology on health outcomes;

3. The technology must improve the net health outcome;

4. The technology must be as beneficial as any established alternatives;

5. The improvement must be attainable outside the investigational setting.

Coding:

CPT Codes:

00740 Anesthesia for upper gastrointestinal endoscopic procedures,

endoscope introduced proximal to duodenum

00810 Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum.

Description of Procedure or Service:

Intravenous sedation and analgesia is routinely administered for gastrointestinal endoscopic examinations to help alleviate patient anxiety and discomfort. Provision of sedation and analgesia for endoscopy procedures is standard practice. 

In the United States, licensed registered nurse or physician assistant administration of intravenous opiate narcotic, usually meperidine (Demerol®), in combination with a benzodiazepine, usually midazolam (Versed®), under the direct supervision of a licensed physician endoscopist is the traditional method for achieving sedation.

Recently propofol (Diprivan) has been used as an alternative method of sedation for patients undergoing endoscopy procedures. Propofol is a short-acting anesthetic agent. 

The advantages of propofol are its rapid induction of sedation, quicker patient recovery time, and anti-emetic effect. The use of propofol requires monitoring for respiratory and/or cardiac collapse by trained personnel.

Appendix D – Requested Professional CPT and HCPCS

Procedure Codes

Code         Description        Modifiers to Report 

00740        Anesthesia           NONE 

Subset: West TN counties no MHSA

Time Period: Incurred YTD          Jan - Oct, 2014       In Network? (Yes =1, No=0)

Provider Name    Provider NPI ID    Provider City    Provider Zip   Provider State Code    Visits Provider Prof

Kimberlin, Gibson D. 1932100740 PARIS 38242 TN 1

PID segment definition

SEQ    LEN     DT      OPT   RP/#  TBL#      ITEM#    ELEMENT NAME

29 26 TS O 00740 Patient Death Date and Time

PWX-00740 codepage_name is not a recognized codepage.

Explanation: The code page name on the PowerExchange configuration file was not recognized.

System Action: PowerExchange returns an error code and message, and abends.

User Response: The codepage name should be one of the standard codepages such as, IBM-037 or a user codepage name such as USRCP01. Correct the codepage name in the PowerExchange configuration file and resubmit.

Average risk screening: Lack of symptoms and abnormalities

X Screening, by definition, is a service performed on a patient in the absence of signs and symptoms.

X Medicare’s definition of average risk is no personal history of adenomatous polyps, colorectal cancer or inflammatory bowel disease, including Crohn’s disease and ulcerative colitis; no family history of colorectal cancers or an adenomatous polyp, familial adenomatous polyposis, or hereditary nonpolyposis colorectal cancer.

X For most payors, a patient is eligible for screening colonoscopy on or after age 50. Some payors allow for screening to begin at age 45 for patients of certain gender and/or ethnic origin. If there are questions, check the summary of plan documents (SPD) and/or the plan’s coverage policies.

X Since Jan. 1, 2011, Medicare waives the co-pay and deductible for the professional and facility fees for screening colonoscopy at 100 percent with no patient financial responsibility.

X In the final rule for 2015, Medicare expanded the waiver of co-pay and deductible to include anesthesia for screening colonoscopy. A -33 modifier should be added to the 00810 anesthesia code to indicate the circumstance was preventive. 

This coverage “trumps” local contractor medical necessity policies now in existence in a screening circumstance. In the circumstance when a screening procedure becomes therapeutic (see next bullet), the PT modifier should be applied to the anesthesia service. A copay will still apply, but the deductible should be waived.

X If the screening colonoscopy is negative, a follow-up procedure is allowed every 10 years by Medicare. The frequency for follow-up for commercial payors is dependent upon the patient coverage/plan, but most follow either CMS policy or the U.S. Multi-Specialty Task Force (MSTF) recommendations.

X Billing for a screening colonoscopy in an average risk patient:

• Medicare: G0121


HCPCS/CPT Codes

00810 – Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum

81528 – Oncology (colorectal) screening, quantitative real-time target and signal amplification of 10 DNA markers (KRAS mutations, promoter methylation of NDRG4 and BMP3) and fecal hemoglobin, utilizing stool, algorithm reported as a positive or
negative result

82270 – Blood, occult, by peroxidase activity (e.g., guaiac), qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening (i.e., patient was provided 3 cards or single triple card for
consecutive collection)

G0104 – Flexible Sigmoidoscopy

G0105 – Colonoscopy (high risk)

G0106 – Barium Enema (alternative to G0104)

G0120 – Barium Enema (alternative to G0105)

G0121 – Colonoscopy (not high risk)

G0328 – Fecal Occult Blood Test (FOBT), immunoassay, 1–3 simultaneous

G0464 – Colorectal cancer screening; stool-based DNA and fecal occult hemoglobin
(e.g., KRAS, NDRG4 and BMP3)

Medicare Beneficiary Pays

81528, 82270, G0104, G0105, G0121, G0328, and G0464:

* Copayment/coinsurance waived

* Deductible waived

Append modifier -33 to the anesthesia CPT code 00810 when you furnish a separately payable anesthesia service in conjunction with a screening colonoscopy (G0105 and G0121) to waive Medicare beneficiary copayment/coinsurance and deductible.

Appendix D – Requested Professional CPT and HCPCS

Procedure Codes

Code Description Modifiers to Report

00170 Anesthesia NONE

00400 Anesthesia NONE

00740 Anesthesia NONE

00790 Anesthesia NONE

00810 Anesthesia NONE

00840 Anesthesia NONE

01400 Anesthesia NONE

01480 Anesthesia NONE

01961 Maternity-Csection NONE

01967 Maternity-Normal NONE

11100 Biopsy, skin lesion 50, 51, 52, AS, AN, ZZ 

00785 ALCAINE       

00790 ALCOHOL

00800 ALCOHOL ISOPROPYL

00805 ALCOHOL RUBBING

00810 ALCON

00825 ALDACTAZIDE

00830 ALDACTONE

00845 ALDOMET

00850 ALDORIL

00866 ALFENTA

00903 ALKALINIZING AGENT

00915 ALKERAN

00960 ALLEREST

00976 ALLERGAN

00980 ALLERGY RELIEF OR SHOTS

00982 ALLERHIST

01000 ALLERPHED C EXPECTORANT

01001 CLARITIN D

01002 NEXIUM

01003 ANAPROX DS

01004 ATUSS EX

01005 ALLERPHED SYRUP

01006 FERRIMIN

01007 TIKOSYN

01008 ZONEGRAN

01012 BUDESONIDE

01014 CORVERT

01016 ADVIL MIGRAINE

01017 BACTRIM DS

01018 MONSEL'S SOLUTION

01019 NIFEDICAL XL

01020 OPTIVAR

01021 BUTORPHANO

d00805 METHAMPHETAMINE

d00806 PHENTERMINE

d00809 PHENDIMETRAZINE

d00810 DIETHYLPROPION

d00813 BENZOCAINE TOPICAL

d00817 HYDROXYCHLOROQUINE

d00824 OPIUM

d00825 LEVORPHANOL

d00833 OXYMORPHONE

d00838 BUTORPHANOL

d00839 NALBUPHINE

d00840 BUPRENORPHINE

d00842 SALSALATE

d00843 SODIUM SALICYLATE

d00844 SODIUM THIOSALICYLATE

d00846 MAGNESIUM SALICYLATE

d00848 DICLOFENAC 

00805 ALCOHOL RUBBING

00810 ALCON

00825 ALDACTAZIDE

00830 ALDACTONE

00835 ALDOCLOR

00845 ALDOMET

00850 ALDORIL

00866 ALFENTA

00880 ALKA-SELTZER

00960 ALLEREST

00976 ALLERGAN 

0780 NORMAL(1l)=AN0*BN0-CNO*DNO

00790 NORMAL(2,1)=CNO*FNO-ENO*8N0

00800 NJRMAL(3,1)=ENO*DNO-ANO*FNO

00810 TYPE 9900,NORMAL

00820 CALL MArMUL(3lV3,DIRCOSNORMAL,NGRMA)

00830 TYE 930tNORMA

00840 9900 FJRMAI(!X,3F10.3)

00850 C

0086V CONST=57.29577951


00870 C

00880NORk4AG=SQRT(NORKA(11f)**2+NOPMA(2t1)**2+NORMA(3,1)**2)

0890 C

00900 DIP=ACOS(ABS(NORMA(3,1)/NORMAG))*CONST

00910 lF(NORMA(1,1).EQ.0.U)STRDIR='N'

00920 IF(NORMA(2,1).E.0.0 )STRDIR='E'

00930 IF(NORMA(2,1)+N0RMA(ll).NE.0.C)GO TO 35

Endoscopy CPT code with Description - Exampl

CPT Code    Description
Examples of Surgical Procedures using Computer Assisted Surgical Navigation
CPT 31254
Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial (anterior)
CPT 31255
Nasal/sinus endoscopy, surgical; with ethmoidectomy, total (anterior and posterior)
CPT 31256
Nasal/sinus endoscopy, surgical, with maxillary antrostomy;

Endoscopy Procedure Code List - BCBS

Endoscopy Procedure Code Table As of June 1,2010

Endoscopy Group	Endoscopy Group Procedure Codes	Base Code
Shoulder Arthioscopy/Surgery	29806 29807 29819 29820 29821 29822 29823 29824 29825 29826 29827 29828	29805
ElbowArthroscopy and Surgery	29834 29835 29836 29837 29838	29830
Wrist Arthroscopy and Surgery	29843 29844 29845 29846 29847	29840
Hip Arthroscopy	29861 29862 29863	29860
Knee Arthroscopy	29871 29873 29874 29875 29876 29877 29879 29880 29881 29882 29883 29884 29885 29886 29887	29870
Laryngoscopy	31510 31511 31512 31513	31505
Laryngoscopy	31527 31528 31529 31530 31535 31540 31560 31570	31525
Laryngoscopy	31531 31536 31541 31545 31546 31561 31571	31526

What is Clear Liquid Diet for Endoscopy

Clear Liquid Diet for Endoscopy

A "clear liquid" means that you can see through it. It should not be dark colored (e.g. cola) and it should not have pulp (e.g. orange or grapefruit juice or any juice that is described as "with pulp" or with "bits of fruit").

You may not have any drinks that are red, blue, or purple. Solid food, milk and milk products are NOT allowed.

How to prepare for Endoscopy

What Preparation is Required for Endoscopy?

For the best (and safest) examination, the stomach must be completely empty.  You should have nothing to eat or drink, including water after midnight the night before your procedure.  Your doctor will be more specific about the time to begin fasting, depending on the time of day that your test is scheduled.

It is best to inform your doctor of your current medications as well as any allergies several days prior to the examination.  You should alert your doctor if your require antibiotics prior to undergoing dental procedures, since you may need antibiotics prior to upper endoscopy as well.

Anesthesia Services for Routine Gastrointestinal Endoscopy

Use of Anesthesia Services for Routine Gastrointestinal Endoscopy - BCBS of Alabama

Policy:

The use of anesthesia services to provide sedation and analgesia for patients for routine gastrointestinal endoscopy procedures does not meet Blue Cross and Blue Shield of Alabama’s medical criteria for coverage except for the following:

• Patients with potential for difficult intubation and/or ventilation with a mask, or at risk for airway obstruction, including but not limited to:

o Patients with previous problems with anesthesia or sedation;

o Patients with a history of stridor or tracheal stenosis

o Patients with a diagnosis of clinically significant sleep apnea;

o Morbidly obese patients;

Use of Anesthesia Services for Routine Gastrointestinal Endoscopy

The following Association Technology Evaluation Criteria must be met for a service/supply to be

considered for coverage:
1. The technology must have final approval from the appropriate government regulatory
bodies;
2. The scientific evidence must permit conclusions concerning the effect of the technology on
health outcomes;
3. The technology must improve the net health outcome;
4. The technology must be as beneficial as any established alternatives;
5. The improvement must be attainable outside the investigational setting.

WHAT HAPPEN AND RESULTS OF THE CAPSULE ENDOSCOPY

SMALL BOWEL CAPSULE ENDOSCOPY 

WHAT HAPPENS AFTER THE CAPSULE ENDOSCOPY?

At the end of the procedure, you will need to go back to your doctor to return the data recorder and sensor array. The images acquired will then be downloaded to a workstation for your doctor to review. After ingesting the capsule and until it is excreted, you should not have a Magnetic Resonance Imaging (MRI) examination or be near an MRI machine.

HOW WILL I KNOW THE RESULTS OF THE CAPSULE ENDOSCOPY?

After you return the equipment, your doctor will process the information from the data recorder and will view a colour video of the pictures taken from the capsule. After the doctor has looked at this video, you will be contacted with the results.

What Happens After Capsule Endoscopy

Understanding Capsule Endoscopy

What Happens After Capsule Endoscopy?

You will be able to drink clear liquids after two hours and eat a light meal after four hours following the capsule ingestion, unless your doctor instructs you otherwise. You will have to avoid vigorous physical activity such as running or jumping during the study. Your doctor generally can tell you the test results within the week following the procedure; however, the results of some tests might take longer

How to prepare for Capsule Endoscopy

How Should I Prepare for the Procedure?

An empty stomach allows for the best and safest examination, so you should have nothing to eat or drink, including water, for approximately twelve hours before the examination. Your doctor will tell you when to start fasting.

Tell your doctor in advance about any medications you take including iron, aspirin, bismuth subsalicylate products and other over-the-counter medications. You might need to adjust your usual dose prior to the examination.

Discuss any allergies to medications as well as medical conditions, such as swallowing disorders and heart or lung disease.

Tell your doctor of the presence of a pacemaker or defibrillator, previous abdominal surgery, or previous history of bowel obstructions in the bowel, inflammatory bowel disease, or adhesions.
Your doctor may ask you to do a bowel prep/cleansing prior to the examination

Understanding Capsule Endoscopy

What is Capsule Endoscopy?

Capsule Endoscopy lets your doctor examine the lining of the middle part of your gastrointestinal tract, which includes the three portions of the small intestine (duodenum, jejunum, ileum). Your doctor will give you a pill sized video camera for you to swallow. This camera has its own light source and takes pictures of your small intestine as it passes through. These pictures are sent to a small recording device you have to wear on your body.
Your doctor will be able to view these pictures at a later time and might be able to provide you with useful information regarding your small intestine.

Why is Capsule Endoscopy Done?

Capsule endoscopy helps your doctor evaluate the small intestine. This part of the bowel cannot be reached by traditional upper endoscopy or by colonoscopy. The most common reason for doing capsule endoscopy is to search for a cause of bleeding from the small intestine. It may also be useful for detecting polyps, inflammatory bowel disease (Crohn’s disease), ulcers, and tumors of the small intestine.

As is the case with most new diagnostic procedures, not all insurance companies are currently reimbursing for this procedure. You may need to check with your own insurance company to ensure that this is a covered benefit.

WHAT ARE THE POSSIBLE COMPLICATIONS OF ENDOSCOPY

 WHAT ARE THE POSSIBLE COMPLICATIONS OF ENDOSCOPY

 Endoscopy is safe. Complications can occur but they are rare when the test is performed by doctors with specialised training and experience in the procedure. Bleeding may occur from a biopsy site, or where a polyp has been removed. This is usually minimal and rarely requires blood transfusions or surgery. Localised irritation of the vein where the medication was injected may cause a tender lump lasting for several weeks but this will go away eventually. Applying heat packs or hot, moist towels may help relieve discomfort. Other potential risks include a reaction to the sedatives/anaesthetic used and complications from heart or lung disease. Major complications, eg. perforation (a tear that may require surgery for repair) are very uncommon and occur less often than once in 10,000 tests. It is important for you to recognise early signs of any possible complications. If you begin to run a fever after the test, begin to have trouble swallowing, or have increasing throat, chest or abdominal pain, let your doctor know about it promptly or contact your local Emergency Department.

You will need to arrange to have someone accompany you home from the examination.