Questions and Answers
The practicing physicians at Gastroenterology Specialists of Oregon have provided this page to provide information to Frequently Asked Questions. If you have a question that is not listed here, please give us a call.
General Questions
How long will the procedure take?
Why does my driver have to stay in the waiting room during my procedure?
I take antibiotics before dental procedures, will I need to take antibiotics before my procedure?
Is the procedure videotaped?
Will I be put to sleep for the procedure?
What medication will I be given?
Will I have pain during the procedure?
Why can't I drive home or take a taxi? When can I drive again?
Why can't I eat seeds before the colonoscopy or sigmoidoscopy?
Will I know what the doctor found? If biopsies are done, how long does it take to get results?
Will I remember the doctor talking to me after the procedure?
How long is the colon?
Is it normal to get chills/cold with the prep? Or nausea or vomiting? How do you handle the slow to eliminate prep?
Are there other preps on the market?
Is yellow fluid after a colon prep OK?
What is a polyp? What do polyps look like? Are all polyps cancerous?
How long will it take to get the air out?
When can I eat? What can I eat?
Will my throat be sore after an EGD?
Why do I need a colonoscopy for colon cancer screening if I have no symptoms?
Procedures
Who will do the procedure?
Billing
Why do I need a referral from my PCP if my insurance company does not require it?
How does a screening colonoscopy differ from a diagnostic colonoscopy? And why didn't my insurance plan pay 100% of the diagnostic colonoscopy charges?
What happens if I need a referral or prior authorization?
If the insurance company told me my procedure was covered, why do I have a balance to pay?
Why are there two charges for the procedure?
Do you have financial assistance available?
Do you offer a “cash at the time of service” discount?
I currently do not have any medical insurance, but my PCP states I need a colonoscopy. What should I expect?
General Questions
How long will the procedure take?
The upper endoscopy procedure takes only about 15-30 minutes. The lower colonoscopy procedure takes about 30-45 minutes on average. Because of preparatory time before your endoscopy and a period of recovery, you and your escort should expect to spend 90-120 minutes at our facility.
Why does my driver have to stay in the waiting room during my procedure?
There are a number of reasons why we would like your driver to stay during your procedure:
1) Timing- We like to bring the patient's driver/family member back as soon as the procedure is done so that this person can be present to hear what the doctor did during the procedure. This is very important as the patient is usually still under the influence of medication and will not remember this important conversation. The length of procedures can be unpredictable at times and we may be done sooner than we thought, if the driver is not here then the information on what happened will not be heard by someone else that is coherent.
2) Safety - If something happens we would want someone here to discuss what is going on with the patient.
3) Comfort - We like our patients to go home after their procedure to the comfort of their own homes. That way they can pass any extra air without feeling embarassed and can sleep for a few hours until the medication completely wears off. If we are finished before the driver arrives then due to space the patient may have to wait in the waiting room which is not the most comfortable place to be after a procedure.
I take antibiotics before dental procedures, will I need to take antibiotics before my procedure?
The American Heart Association has developed guidelines for identifying need for antibiotics before endoscopic procedures. These may differ from your dentists requirement for antibiotics before dental work. Discuss your need for pre-procedure antibiotics with your doctor if you have any concerns. They are administered primarily for patients who have artificial heart valves.
Is the procedure videotaped?
The images generated during your procedure are seen on a TV monitor. We do not have the capability to videotape procedures. Your physician may store some still images in your medical record for later reference.
Will I be put to sleep for the procedure?
You will NOT be given a general anesthetic as when a patient has major surgery. You will be given medication through an IV site that will cause relaxation. Many patients have no memory of their procedure when completed due to the medications' effects.
What medication will I be given?
Medicines are given in the vein through an IV port placed in your hand or arm. Medication dosage and type may vary depending on your individual needs. Generally, a narcotic medication such as Demerol or Fentanyl is used in addition to a drug called Versed, which has effects similar to Valium. For an upper endoscopy, a spray may be used to numb your throat and to help prevent gagging. It contains a medicine very similar to that used by your dentist for dental work.
Will I have pain during the procedure?
Upper endoscopy is generally painless except for a feeling of mild transient fullness as the scope is passed through the mouth and throat. The majority of colonoscopy patients note no discomfort during the procedure. A few patients will remember some mild cramping and discomfort during the procedure. A small number of patients will experience significant discomfort during the exam. There is usually no pain after the procedure other than mild bloating in the first hour as gas passes out of the colon.
Why can't I drive home or take a taxi? When can I drive again?
The medicines you are given have much the same effect on the brain function as alcohol. In addition, the effects of the medicine stay in the body for several hours and will affect judgment and reaction time long after the patient feels the medicine is gone. You may take a medical taxi home provided you have an escort to assure that you arrive safely at your destination.
In general, all the effects of your sedation will be gone by the morning after your procedure. You will have no restrictions at that time.
Why can't I eat seeds before the colonoscopy or sigmoidoscopy?
Seeds may remain in the bowel following the preparation for colonoscopy. During the procedure they may be suctioned into the endoscope and damage the instrument. Avoiding seeds for a week before the procedure will help prevent this problem.
Will I know what the doctor found? If biopsies are done, how long does it take to get results?
Your doctor will talk to you after your procedure. He/she will tell you at that time what was seen. If biopsies are taken, or polyps removed, you will know the results in 2-3 weeks. You will be contacted by phone or letter about your results with instructions for follow-up, if necessary. You will receive results even if the pathology is normal. If you have not heard from us within four weeks, call the office to let us know. We will give you your results at that time.
Will I remember the doctor talking to me after the procedure?
One of the sedation medicines (Versed) you are given causes amnesia. After your procedure you may be alert, able to follow commands and ask questions, but you may not remember any events. Your doctor will talk with you after your exam. We encourage your escort to be with you at that time so they can hear the discussion in case you have any questions later. The day after your exam, one of our nurses will be calling to check how you are doing and can answer questions for you at that time or refer you to your physician if appropriate.
How long is the colon?
The colon is folded on itself like an accordion so it is difficult to state its length. In general, the colon is 4-5 feet long.
Is it normal to get chills/cold with the prep? Or nausea or vomiting? How do you handle the slow to eliminate prep?
If you use the large volume preparation such as GoLyte, NuLyte, CoLyte, the following should be considered:
• After mixing the solution at noon, place in the refrigerator. When you start the prep in the evening, take about 2 quarts out of the refrigerator and drink as scheduled. When the 2 quarts are gone, refill the container and continue this pattern until all the prep is taken. This will keep the solution cold enough to help keep the taste from getting too salty but not so cold that it will chill your body. Occasionally, you may feel chilled.
• Ten percent of patients will have nausea and vomiting with the prep. If you are becoming nauseated, stop the liquid and wait 45-60 minutes. Restart the prep at one glass every 15-20 minutes until it is gone. If you continue to vomit, phone the doctor on call (503) 692-3750.
• The amount of time needed for the liquid to cause diarrhea varies, it can take up to 4 or more hours.
If you use the Fleets phospho-soda prep, the following should be considered:
• Drink the Fleets phospho-soda slowly. Chilling will help you to tolerate the solution.
• Be sure to drink at least six-8 oz. glasses of water after the phospho-soda.
• Be sure to take the second half of your prep at least 4 hours before your procedure to allow time for the prep to be finished and to allow yourself travel time.
Are there other preps on the market?
Three preparations are available for colon cleansing prior to colonoscopy. No cleansing prep is needed for upper endoscopy.
Is yellow fluid after a colon prep OK?
Some residual liquid in the colon is normal after preparation for colonoscopy. Since the body continues to produce bile even if you do not eat, this bile will color the liquid yellow. Small to moderate amounts of clear or cloudy yellow liquid eliminated from the rectum is normal the day of colonoscopy.
What is a polyp? What do polyps look like? Are all polyps cancerous?
Colon polyps are small growths that develop on the inside wall of the colon. These start very small (1-2 millimeters, the size of a small ant) and slowly grow larger. Many are shaped like a mushroom or a cauliflower. It takes years for the average polyp to reach 1 cm in size (the size of a pea). The larger the polyp, the higher the cancer risk.
Most polyps cause no symptoms. Most polyps can be removed at the time of your colonoscopy. You will generally feel no pain or sensation when polyps are removed. There is a very small risk of bleeding in the colon at the polyp removal site, which could require hospitalization or blood transfusion. Rarely polyp site bleeding will require surgery.
All polyps that are removed are sent to the pathology lab for evaluation. Two types of polyps can be found. Hyperplastic polyps have no risk of recurrence or malignancy (formation of cancer). Adenomatous polyps are pre-cancerous and do tend to recur elsewhere in the colon and therefore require a follow-up exam. Your doctor cannot visually distinguish hyperplastic from adenomatous polyps, so microscopic examination is required. Your doctor will contact you by phone or letter about results if a polyp has been removed. If you have not heard from your doctor in 4 weeks, please call the office for results.
How long will it take to get the air out?
Most people are able to pass all the air out of their GI tract within 1-2 hours after the procedure. Walking about or lying on the left side may help to eliminate the air.
When can I eat? What can I eat?
Unless instructed otherwise, you should wait 2 hours after your procedure to have a meal to be assured that all gas has passed out of the GI tract and you are alert enough to eat.
Unless instructed otherwise, you will have no dietary limitations after your procedure. You should drink no alcohol for 24 hours because of the sedation medicine you were given for your procedure.
Will my throat be sore after an EGD?
You will be given a medicine by spray to the back of your throat to prevent gagging. Your throat will feel numb for 1-2 hours. You may have mild soreness for the rest of the day, especially if you underwent dilatation. Severe throat pain or pain that persists for more then 48 hours should be reported to your doctor.
Why do I need a colonoscopy for colon cancer screening if I have no symptoms?
Colon cancer rarely shows symptoms until much later in the disease. It is the second-leading cause of cancer deaths in the U.S., which is why screening has become so important.
For details regarding colon cancer screening see the following link: http://www.cancer.gov/cancertopics/factsheet/Detection/colorectal-screening
Procedures
Who will do the procedure?
Unless you are instructed otherwise, the physician who saw you at your initial office visit will do your procedure. All our physicians are specially trained in endoscopic procedures. Nursing staff will help prepare you for your procedure and will assist the doctor during the procedure.
Billing
Why do I need a referral from my PCP if my insurance company does not require it?
Although your insurance company doesn't require a written referral, our office policy is that we have a "referral" (invitation) by your PCP to render services to you. We have found that patients who have their medical care managed by a PCP, tend to have better outcomes. It is important for us to know that your care is being managed by a physician who is going to look at the overall picture for you; including your medications, diagnostic tests that are needed, preventive services required, etc. You can schedule your routine colonoscopy without an "invitation" from your PCP, just check with your insurance carrier to make sure you don’t need a written referral (authorization).
How does a screening colonoscopy differ from a diagnostic colonoscopy? And why didn't my insurance plan pay 100% of the diagnostic colonoscopy charges?
A screening colonoscopy is when a colonoscopy is done when the patient is asymptomic (meaning the patient has no symptoms...like diarrhea or rectal bleeding). Some insurance plans pay for a screening colonoscopy every 10 years (for example) as part of their preventive medicine benefit package. Usually the screening visit and procedure charges are not applied to the patient's deductible, and the patient may not have to pay a copay (and/or co-insurance).
A diagnostic colonoscopy is done when a patient has symptoms (again, diarrhea or rectal bleeding). Usually the charges for a diagnostic service are applied to the patient's deductible, and copayments and co-insurance amounts are collected.
Many patients are frustrated when they have been scheduled for a screening colonoscopy and during the colonoscopy polyps are found. When the colonoscopy charge is submitted, it is no longer a screening exam, but it is considered diagnostic because a problem or symptom was found.
Please understand that we are required to accurately code the visit and/or procedure by what was found during the visit or procedure. Failure to accurately code is considered Fraud and Abuse.
What happens if I need a referral or prior authorization?
It is the patient's responsibility to request a referral from their Primary Care Physician (PCP), prior to scheduling an appointment with our office. In general, the PCP's are very good about submitting a referral to us in a timely manner, but its always best to follow up with your PCP to assure that the referral has been sent to us. If our physicians recommend a procedure and/or test that requires a prior authorization, then our Referral Specialist will submit the prior authorization request on your behalf.
If the insurance company told me my procedure was covered, why do I have a balance to pay?
From the insurance standpoint, services are either "covered" or "non-covered". If a service is "non-covered" it means that the insurance company will not pay for any of it, and it does not apply to your deductible. Examples of non-covered services are cosmetic surgery, experimental procedures, etc. If the services are "covered", then the charges for those services are applied to your deductible. And based on your insurance plan, you are responsible for paying a co-payment and/or co-insurance, and your remaining deductible amount.
Why are there two charges for the procedure?
One charge is for the professional component, i.e. the services provided by the physician. The second charge is for the facility fee, which covers the cost of the Endoscopy Center and its related expenses.
Do you have financial assistance available?
Yes. We offer financial assistance for patients who meet the income guidelines. Patients who seek financial assistance are asked to fill out a Financial Assistance Request Form and must submit a copy of their most current 1040 Federal Income Tax form.
Do you offer a “cash at the time of service” discount?
At this time, we do not offer a cash discount.
I currently do not have any medical insurance, but my PCP states I need a colonoscopy. What should I expect?
First, you will be required to pay a deposit of $75.00 for the initial office visit. The $75.00 deposit will be applied to the charges for your office visit, and you will be billed for any remaining balance.
If you are scheduled for a non-urgent procedure, you will be required to pay a $500 deposit toward the facility charges. As mentioned above, you will receive two charges; one for the physician services and the other for the facility fees. If needed, you can request a payment plan or complete the Financial Assistance forms to determine if you qualify for financial assistance.
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