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Common Procedures and Treatments

Screening Colonoscopy

Colon Cancer is the 2nd leading cause of death in the United States, second only to lung cancer. It affects males and females equally. It has now been scientifically established that almost every colon cancer develops in benign colon polyps, and that it takes about ten years for a polyp to become malignant. During this period of time, or "window of opportunity", if a polyp is found, and removed, colon cancer may be prevented. Unfortunately, during the polyp evolution period, these growths are silent - i.e. generate no symptoms. Approximately 25% of the population over the age of 50, without symptoms or other risk factors, will harbor premalignant polyps (adenomas). If risk factors are present such as family history of colon polyps or colon cancer, the rate is slightly higher.

Another disturbing observation involves the distribution of polyps within the colon. Polyp formation has been noted to be shifting, with time, increasingly, toward the right colon above reach of the flexible sigmoidoscope. Because of this so called proximal migration of polyps, only 50% of polyps today will be discovered by the shorter office screening instrument. Current national guidelines for colorectal cancer screening recommend it for everyone beginning at age 50.

What has kept screening colonoscopy from being universally recommended has been the fact that it is costly, not covered by most third party insurers, and slightly more invasive than the other tests.

GENERAL INSURANCE INFORMATION

A screening colonoscopy is now recommended and paid for by Medicare for average risk individuals without symptoms every 10 years according to the following criteria:

• Individuals not meeting the criteria for being at high risk for developing colorectal cancer.
• Colonoscopy at a frequency of once every 10 years
• Individual must wait a period of 47 months after a screening flexible sigmoidoscopy before qualifying for a covered screening colonoscopy.

Other insurance companies are gradually adding coverage for screening colonoscopy, but unfortunately some do not cover the procedure. Therefore, the asymptomatic individual (who has a 15-25% risk of having polyps) may be responsible themselves for payment depending on the insurance companies policies.

For this reason, we require the patient to sign a waiver which places him/her as being financially responsible.

SPECIAL PROBLEMS

If polyps are found during the screening colonoscopy, we would plan to remove them at the time (the reason for having the exam). In this situation, we would submit bills to the insurance company with the diagnosis of colon polyp. Medicare and many insurers will then cover the procedure. Some carriers, however, have pre-certification requirements before the procedure, and these companies will not cover the removal of polyps because the exam had not been pre-certified. If a polyp is removed, the individual will be billed an additional fee.

Also, the individual can expect a bill from the pathology laboratory. We would then expect a subsequent follow up exam in these individuals to be covered by virtue of the "risk factor" of a previous colon polyp.

PATIENT RESPONSIBILITY

The physicians at North Texas Colon and Rectal are happy to provide this service for interested individuals without preliminary consultation. A preliminary phone conversation may be needed to determine the need for a pre-procedure consultation. Regardless, we welcome a chance to meet with patients in the office to discuss the procedure in more detail.

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