Colonoscopy (with polyp removal)

What it is

Most cancers of the colon begin as a polyp — a small growth on the lining that is harmless for years before it is not. The reason a colonoscopy is worth doing is that the same instrument that finds a polyp can take it out in the same sitting. This code covers that: a flexible scope is passed through the rectum along the length of the large intestine, and when a growth is found, a thin wire loop is fed down a channel in the scope, placed around the base of the polyp, and closed to cut it free. The tissue is retrieved and sent to a pathologist. Patients feel none of the removal itself; the colon lining has no sensation of that kind.

Why it is done

• To remove polyps found during the exam, so they cannot go on to become cancer
• To take out a growth in one piece so a pathologist can tell what it was and whether the edges are clear
• To deal with a lesion seen on an earlier study or on imaging
• To clear polyps in someone being followed because polyps were found before

What to expect

Preparation is the demanding part and it is identical whether or not a polyp turns up: a low-fiber diet for a few days, clear liquids, and a bowel-cleansing laxative regimen. Sedation is given through an IV during the procedure, and most people remember little of it. Recovery at the facility takes half an hour to an hour, with cramping and bloating while the air used to open the colon works its way out. A driver is required. Light bleeding in the days after a polyp removal is expected; heavy bleeding or severe pain is not. The pathology result comes back days to a couple of weeks later.

Questions worth asking

• Whether a polyp is found is only known once the exam is underway. If my procedure was booked as screening, does removing a polyp turn it into a diagnostic service under my plan, with cost sharing attached?
• Polyps can be removed by snare, by forceps, or by other techniques, and each is a different code. Which will be billed, and can I get the estimate for each?
• If several polyps are removed, is the procedure billed once or more than once?
• Which pathology laboratory reads the specimens, and is it in network? That choice is usually made by the practice, not by me.