Colonoscopy (With Biopsy)

What it is

The exam is the same as any other colonoscopy: a flexible scope with a camera is passed through the rectum and along the large intestine. What distinguishes this code is that the doctor passed a small forceps through a channel in the scope and pinched off one or more pieces of the lining to send to a laboratory. Taking a biopsy is not felt by the patient — the lining of the colon has no pain nerves of the kind that skin does — and it adds only a short time to the procedure. It is a different billing code from a look-only colonoscopy, and a different one again from removing a polyp with a snare.

Why it is done

• To sample an area of lining that looked abnormal during the exam, so a pathologist can say what it actually is
• To confirm or rule out inflammatory bowel disease, where the diagnosis often depends on what the tissue looks like under a microscope rather than on the view through the scope
• To investigate chronic diarrhea, where the lining can look normal and the answer shows up only in the samples
• To sample a growth that cannot be removed in one piece during the same session

What to expect

Preparation and sedation are identical to any colonoscopy: a bowel-cleansing regimen and clear liquids beforehand, sedation during, and no driving for the rest of the day. Whether a biopsy is taken is usually decided during the procedure, based on what the doctor sees, so it is not always known in advance. Results are not immediate — the samples go to a pathologist, and it generally takes several days to a couple of weeks before a report comes back.

Questions worth asking

• Which pathology lab will read the samples, and is that lab in network? The lab is often chosen by the practice, not by you, and bills you separately.
• How many separate specimen jars are expected? Pathology is frequently billed per specimen, not per procedure.
• A screening colonoscopy that turns into a biopsy can be reprocessed as diagnostic. Does my plan still cover it as preventive if tissue is taken?
• Are the facility fee, the physician fee, the anesthesia fee, and the pathology fee all quoted in any price estimate I'm given, or only some of them?