Colonoscopy (Diagnostic)

What it is

A colonoscope is a thin, flexible tube with a light and a camera on the end. A doctor passes it through the rectum and advances it along the large intestine, watching the lining on a monitor and looking again as the scope is withdrawn. This particular code describes the exam on its own — the doctor looked, and did not take a tissue sample or remove anything. It is the simplest version of the procedure, and the one most people picture when they hear the word.

Why it is done

• To screen for colorectal cancer and for polyps, which are growths that can become cancer over time
• To look into symptoms such as bleeding from the rectum, blood in the stool, persistent abdominal pain, or a lasting change in bowel habits
• To follow up on an abnormal result from a stool test or an imaging study
• To check the colon again after previous polyps, cancer, or a diagnosis of inflammatory bowel disease

What to expect

The preparation matters more than the exam. In the day or so beforehand, patients drink a bowel-cleansing solution and stay on clear liquids, because the colon has to be empty for the lining to be visible. The exam itself usually takes under an hour and is done with sedation, so most people remember little or nothing of it. Sedation means someone else has to drive home afterward, and the rest of the day is usually written off. Bloating and cramping for an hour or two are common, and most people are back to normal the next day.

Questions worth asking

• Is this being ordered as a screening colonoscopy or a diagnostic one? The two are often covered differently, and the answer can change what you owe even though the exam is identical.
• If a polyp is found and removed, the code and the price change mid- procedure. What would that cost, and does my plan still treat it as preventive?
• Who else bills separately — the anesthesia provider, the facility, the pathologist — and are all of them in network at this location?
• Is this being done at a hospital outpatient department or a freestanding endoscopy center? The facility fee is often the largest single line.