Preventative Colonoscopy Shock

[Teacher Terry]

Colonoscopy does carry the risk of perforating your colon which is often fatal. As you age the lining of your colon gets thinner. One of my friends had her last one at 70 for this reason. Not sure what I intend to do.

[braumeister]

Quote:

Originally Posted by Teacher Terry Colonoscopy does carry the risk of perforating your colon which is often fatal. As you age the lining of your colon gets thinner. One of my friends had her last one at 70 for this reason. Not sure what I intend to do.

That's a legitimate concern. The guy who has done all three of mine said that he discourages anyone over 75 from having it done for this reason.

[fh2000]

I did my 3rd colonoscopy late last year. Surgical center changed $8,230, and I pay $0. Doctor removed 2 polyps and sent to do biopsy. I got 2 bills. I paid the doctor $120 and pathology $65. Both polyps are benign.

[Live And Learn]

Quote:

Originally Posted by Bamaman While you are being proactive with your healthcare, are you having a full physical including a chest xray every year?

Actually yes but not an xray - I get a low dose lung cancer CT screening. It's $99 and well worth it after having smoked from age 16 - 45 and was subject to second hand smoke from conception !

[upset264]

This is not an area to cut corners. I was reluctant to have my first. Always told the doctor I'll do it but not right now. One day he asked if an intern could do my exam. She asked me about colonoscopy. I said yes I'm going to get one someday. She said, "well lets set that up right now". I didn't argue knowing it was the right thing to do.

They found a couple of large pre-cancerous polyps. I had to have surgey and remove four inches of my intestine. I'll always remember that doctor. She probably saved my life or at a minimum a whole lot of trouble.

[MBSC]

Quote:

Originally Posted by Rianne My DH, 60 yrs old, signed up for a colonoscopy. Since it's a preventative there's no cost to us, or so we thought. I started reading articles where people had the preventative colonoscopy. They found benign polyps and were charged for diagnostic colonoscopy, big difference!

This was common on non-Medicare claims before the ACA. For a screening colonoscopy under the ACA, the provider now bills modifier 33 with the procedure code to prevent cost sharing.

If the provider forgets to bill the modifier and cost sharing is applied, the provider submits a 'corrected claim' with the modifier and the cost share is removed.

If the colonscopy is being performed due to symptoms (pain, bleeding), it is diagnostic and cost sharing does apply.

Quote:

A screening test is a test provided to a patient in the absence of signs or symptoms based on the patient’s age, gender, medical history and family history according to medical guidelines. Whether a polyp or cancer is ultimately found does not change the screening intent of that procedure. Screening Colonoscopy for Non-Medicare Patients that becomes Diagnostic or Therapeutic When a screening colonoscopy converts to a diagnostic or therapeutic procedure for a non-Medicare patient, the surgeon must document that the intent of the procedure was screening in order for the patient’s insurance to process the claim without out-of-pocket expense in accordance with the ACA. CPT developed the 33 modifier for preventive services... For example, if a surgeon performing a screening colonoscopy finds and removes a polyp with a snare, use CPT code 45385 and append modifier 33 to the CPT code. Reference: Colonoscopy Coding Guidelines | Screening Colonoscopy | ICD 10 & Modifier 33

[MRG]

My ACA policy covered conolosocy and polyop removal. If I received any bill it was minimal.

Forgive my ignorance but I thought once you had a polyop you were considered higher risk and cologaurd was no longer a viable option. I know it's not for me with both polyop and a sibling who had colon cancer.

My sibling almost let her fear of the procedure end her life. Please get tested!

[Bflotomny]

For DW & I it is not the cost of the procedure but the miserable prep. DW she was required to dose 3 times with each colonoscopy, (last year and 15 years ago.) But last year the prep process began at 5-6PM with the last dose at 4AM. Nothing like trying to sleep and then waking up to take meds.
15 years ago you began prep at noon the day before and were finished at midnight. What did they not see at midnight that they can see at 4AM??

[Ian S]

Quote:

Originally Posted by Bflotomny For DW & I it is not the cost of the procedure but the miserable prep. DW she was required to dose 3 times with each colonoscopy, (last year and 15 years ago.) But last year the prep process began at 5-6PM with the last dose at 4AM. Nothing like trying to sleep and then waking up to take meds. 15 years ago you began prep at noon the day before and were finished at midnight. What did they not see at midnight that they can see at 4AM??

There are a lot of prep methods and I think it comes down to what the individual gastroenterologist prefers. My doctor's group has several different ones but with me, my doc only seems to use one (Miralax/Ducolax/Gatorade) that utilizes inexpensive OTC materials with choice of flavor and that cleans me out well. I've never had a problem getting a good sleep (been on a 3 yr schedule due to polyps) but this year i had to get up before 6 am for the last step, a bottle of magnesium citrate. One thing I believe helps is to eat lightly two days prior to the procedure. Less material seems to translate into faster/easier clean out.

I would strongly urge that folks get their first colonoscopy when recommended i.e. age 50 for most. Don't rely on alternates. If you're like most people, you'll have no polyps and thereafter be on a ten year schedule. Cologuard actually states in ads that it's not for people with polyps so maybe after a polyp-free colonoscopy, Cologuard would be appropriate for the following decade.

[Rianne]

Appreciate the comments. Our hospital does charge for removing and biopsy of one or more polyps regardless of biopsy. The hospital and the insurance are linked as the hospital is self insured, it is not one of the big HI companies. Setting cost aside, there is no colon cancer in my large family, including blood relatives on my parents both sides. I guess every cell in the body has a possibility to become cancer. That brings to mind kidneys, lungs, liver, spleen, pancreas...there are no pre cancerous tests for those. Not sure why all the focus is on breast and colon cancer.

[braumeister]

Quote:

Originally Posted by Rianne Not sure why all the focus is on breast and colon cancer.

Because if you're not a smoker they are the biggest killers.

https://www.livescience.com/11041-10...cers-cure.html

[Hamlet]

I had my first colonoscopy this year at 45 because of family history.

The procedure wasn’t bad at all. They gave me the options of being knocked out, being awake but sedated, or no drugs at all. I took the awake but sedated option and I think that is the way to go. No risk of not waking up, but no pain or real discomfort.

The prep was moderately unpleasant.

My cost was a couple of thousand with my less than top of the line insurance.

[HtownRose]

Wait, we're supposed to have a chest x-ray every year? I think I've maybe had 1 my whole life, when I was in my 20s...seem to recall it was before another procedure. Never smoked, but grew up in a smoking household so plenty of 2nd hand exposure my first 18 years.

[JoeWras]

Quote:

Originally Posted by braumeister Because if you're not a smoker they are the biggest killers. https://www.livescience.com/11041-10...cers-cure.html

And young people killers (say, less than 75).

Lots of lung cancer in my parents' generation. In my generation, where smoking is less pervasive or shorter lived, I'm seeing many peers have significant problems with colon and breast cancer. One first cousin nearly died from colon cancer in his 50s. We had a church friend die from it at 47. There have been a few people at w*rk treated for it.

Based on the genes I share with my cousin, even if only 1/16th, I decided to get the colonoscopy at 50 and it saved my life. No cancer, but significant high grade polyps which were even making me slightly anemic, even though I passed the fecal occult test every year.

I've now had 3. 2 of the 3 had polyps. Despite being on a high deductible health plan (for HSA), I have been asked to pay $0 for all if it, including the biopsies.

Now about that article... Pancreatic cancer is sneaking up the list. I pray our smart medical people in this world get a handle on the "why," and the "how" to stop this menace.

[Rianne]

Quote:

Originally Posted by braumeister Because if you're not a smoker they are the biggest killers. https://www.livescience.com/11041-10...cers-cure.html

Good article. I guess my question is, if the preventative measures are working, why are they the biggest killers? And if smoking is one of the causes of lung cancer, could diet, exercise and lifestyle be the cause of those cancers?

I'm not trying to persuade anyone to change their mind on how to live their lives or thinking on medical issues. Medicine has come a long way. When I was 35 yrs. old, I had pre cancerous testing for breast cancer. I have ductal and lobular carcinoma in-situ and it was considered pre cancerous. My oncologist and surgeon pressured me to get chemo, radiation and a double mastectomy. Now, those pre cancer diagnosis are no longer considered a cancer threat. I did not follow the doctors suggestions and am cancer free today.

Do not take my personal experience as something you would do. Sure, I know people who never smoked in their lives and have lung cancer. How you treat your body is your choice. Obesity is a choice and we have the highest rate of obesity in the world. Could obesity be a cause of cancer?

My original post did not say..."everybody change the way you get screened for colon cancer" yet everyone is trying to say I should get a colonoscopy. I don't want to get a colonoscopy. My personal opinion is the cancer industry is huge. If we found a cure for cancer, an entire industry would collapse and millions would be out of work.

If you're interested in why I think the way I do about certain aspects of the medical industry, I'll share this podcast.

https://www.peoplespharmacy.com/2018...-big-business/

[JoeWras]

Quote:

Originally Posted by Rianne My original post did not say..."everybody change the way you get screened for colon cancer" yet everyone is trying to say I should get a colonoscopy. I don't want to get a colonoscopy. My personal opinion is the cancer industry is huge. If we found a cure for cancer, an entire industry would collapse and millions would be out of work.

You absolutely should be free to not get the screening, especially if you don't like the risks. And there are risks. For sure, feel free to seek alternatives. No pressure here, except our experiences may apply a little psychological pressure. For this, I apologize.

It saved my life, but my life has nothing to do with yours. YMMV.

[Henry Lili]

First one in January at age 51. Five polyps found and removed during procedure. No charge to me

[Teacher Terry]

I agree that either the Colonguard or colonoscopy is a reasonable choice. The first one doesn't detect polyps but the second has risks that the first does not.

[michelek]

I am scheduled for a routine colonoscopy. I went in to the doc for the first meeting and received a bill for the office visit for $275. Shouldn’t that be part of the procedure? I was surprised to get a bill for the initial meeting/ appointment to schedule the routine colonoscopy.

[fh2000]

Quote:

Originally Posted by michelek I am scheduled for a routine colonoscopy. I went in to the doc for the first meeting and received a bill for the office visit for $275. Shouldn’t that be part of the procedure? I was surprised to get a bill for the initial meeting/ appointment to schedule the routine colonoscopy.

In my case, no. That is a consultation and doctor billed the insurance separately from the procedure. I had other surgeries and the first or second meetings with doctors are also billed separately from the procedure itself.