A: Not accepting assignment does not mean we do not see Medicare patients or that we do not bill Medicare. It means Medicare will send you any reimbursement owed to us. You are responsible for payment of the bill for services rendered. Since we do not accept assignment, we expect that you will pay the Medicare mandated amount for the services at the time of service. By not accepting assignment, we can expect the slightly higher Medicare mandated fee than the assigned Medicare fee schedule allows.
A: A sigmoidoscopy evaluates approximately 1/3 of the colon and a colonoscopy evaluates the entire colon. Sigmoidoscopy is done without sedation. Sigmoidoscopy has fallen out of favor for colorectal cancer screening due to its limitations, but may be used to address specific problems known to be within its reach.
A: Lower GI is another term for barium enema. This is an older test in which barium, a liquid metal paste, is given by enema until the colon is filled up. X-rays are done to identify polyps or other lesions. If the study does identify polyps, a therapeutic procedure to remove them will still be necessary. The combination of diagnostic and therapeutic options, the more thorough exam, and the sedation of colonoscopy have made it the all-around standard procedure.
A: An upper GI is an x-ray test where the patient swallows barium, a liquid metal. This outlines the upper GI tract and x-rays are taken. The test is useful in many ways, but has significant limitations.
A: Please check with the individual doctor’s office if you are an established patient, so that they can review your chart and let you know. Most patients with polyps have colonoscopy every 3-5 years. Patients with a family history of colon cancer, but without recent polyps, usually have colonoscopies every 5 years. Routine colonoscopies are generally done every 7-10 years.
A: Biopsy results are usually available in 5-7 days. Your doctor will give you instructions at the time of discharge from the GI Lab on how to expect your results and when.
A: There may be some mild cramping during colonoscopy from air that is inserted through the scope, or pressure from passage of the scope around turns. Sometimes the nurse will put pressure on the patient’s abdomen to keep the scope from looping. Most procedures are done under ‘conscious sedation’, so patients are in a light sleep state and are very relaxed.
A: Conscious sedation, or ‘twilight anesthesia’, is a state in which the patient is lightly asleep but arousable and interactive. We use a combination of narcotics (like Demerol or Fentanyl) and relaxant agents (like Versed, which is similar to Valium). These agents put the patient in a very relaxed and ‘dream-like’ state. Most patients are aware the procedure took place but are ‘disconnected’ or cannot remember many of the details.
A: Medicare covers colonoscopy at varying intervals depending on your medical problems (polyps, family history, etc.) or symptoms. Medicare covers screening colonoscopy every 10 yrs.
A: Screening refers to an exam done for routine purposes, at a standard age, or at a standard interval, in the absence of any symptoms. A diagnostic examination refers to one done for a specific reason. For example, you may not be due for a screening examination for 5 years. If your doctor finds blood in your stool sample, however, he or she may refer you for a diagnostic colonoscopy to evaluate this finding.
A: Please see the Mapquest links in each doctor’s section.
A: Please check with the individual physician’s office as this can get complicated. Our printed instructions usually cover the details.
1) You are usually asked to stop all aspirin-like products (Aleve, Advil, ibuprofen, naproxen, etc.) that you might be taking for non-medical reasons. You should stop these for 5 days if possible. A complete list of such medications can be found here:
2) Aspirin, coumadin, and Plavix should be continued if you are taking it for medically-documented stroke or heart disease and under the advice of your physician. You should discuss with your physician whether or not it is safe to stop the medication for 5 days prior to the procedure.
3) Diabetic patients should check with their primary care physician’s office for specific glucose management. All patient’s with diabetes should hold the use of metformin-containing drugs for 24 hours prior to their procedure. You should not take any diabetes medications the day of the procedure. Bring any necessary medications with you.
4) For colonoscopy, we ask that you hold any iron-containing preparations for the week prior.
A: The fact is that people are at risk in all aspects of their lives, some are small risks and some much more real. When we make medical decisions, we are influencing those risks. Sometimes there is risk in both making a decision and its alternative. Blood thinner use during therapeutic gastrointestinal procedures is an example of this. If you are at risk for a heart attack or stroke, your doctor may advise aspirin, Plavix (clopidogrel), or coumadin to reduce this risk. When we remove polyps or perform other therapeutic procedures, there is always some risk of bleeding. When a patient is on aspirin, the risk of bleeding is heightened. Of course, a stroke or heart attack is much more serious than bleeding after a GI procedure. Still, that doesn’t change the fact that bleeding after a polyp removal is potentially important, and an issue that may be more serious than if the patient were not on blood thinners. As for many things in modern medicine, this is a complex issue that demands informed discussion with your primary care physician. For more technical reading, you can see the following example article on these issues: Click here
For the following position statement by the ASGE: Click here
A: Some of our offices do. Please call ahead to inquire.
A: The actual procedure time is only 20-40 minutes, but expect to be at the hospital for 2-3 hours on average.
A: You will not be able to drive for the rest of the day, should not exercise, should not drink alcohol, and should refrain from making important decisions or operating machinery. Most activities can be resumed the day after your procedure unless your physician directs you otherwise at discharge.
A: Liquids that you can see light through, like apple juice, sprite, water and chicken broth. We ask that you avoid red and purple fluids.
A: You must call your GI physician if you cannot complete the preparation. We may be able to offer you an alternative.
A: You cannot drive yourself home. A taxi may be taken home only if you have a friend or family member with you to assure that the taxi takes you to the right place. No one will be released from the GI Lab unless they are accompanied by someone they know.
A: There is a Medicar service, which is a medical car and trained driver who can get you home and inside by accepting additional responsibility. Arrangements have to be made ahead of time, and fees are charged. You can contact the GI Lab for further information.
A: It is an anti-nausea medication. Take it before consuming the liquid bowel prep if you are prone to nausea, and if your doctor has prescribed it. This is not a routinely used part of the bowel preparation.
A: A polyp is a growth of tissue on the lining of the colon that is usually benign. Some of these growths can eventually grow into colon cancer.
A: It is okay to have a colonoscopy when you are menstruating. You should have pads available if your doctor wants you to remove your tampon before the procedure.
A: No. The American Society for Gastrointestinal Endoscopy and the American Heart Association have issued a joint statement that antibiotics are not required for routine endoscopic procedures under almost any circumstances. Antibiotics are not needed for a history of valvular heart disease. Antibiotics are not needed for a history of joint replacement, although many orthopedic surgeons insist that you take them.
For more detailed reading, please visit this technical article: Click here
A: Yes. You should take the prep until your stools are clear like water. Also, you should be aware that you will make some stool overnight (even while fasting) and just because you are clear in the evening does not mean you will still be clear the following morning.
A: Yes. Being small in frame or petite does not mean you will need less prep. You will likely need the same amount of prep as a larger individual.
A: Phosphosoda based preparations were commonly used in the past, and were very effective. Both the two small liquid doses and the pills contain this material. It has been associated with kidney damage and there is currently a black-box warning from the FDA regarding its use. Our practice, with the best interests of your health in mind, does not use this type of preparation.
For more information, please see the following: Click here
A: The accuracy of your examination is directly proportional to the cleanliness of your colon at the time of the exam. In other words, if you want us to find all the polyps, you need to be completely clean. And if you are going to the effort to get this done, get it done right and be good to go for years to come.
A: Gastroenterology Consultants of the North Shore has been active in the early detection and removal of flat polyps for many years. Narrow-band imaging, which utilizes a different wavelength of light to help identify subtle lesions, is being routinely used to assist in the detection of flat polyps. Additionally, high-definition cameras and video screens are utilized at each of our hospitals. Research looking at sentinel markers for even the smallest lesions is an ongoing endeavor that our group is involved with.