Endoscopy

For Members:

• An upper endoscopy is a procedure used to visually examine your upper digestive system with a tiny camera on the end of a long, flexible tube. You have to swallow the tube during the procedure.

• An upper endoscopy requires that you have an empty stomach before the procedure. Do not eat or drink anything for at least six hours before the procedure, or as directed by your doctor or nurse. Ask your doctor for details… Before the upper endoscopy, tell your doctor about any medications (including over-the-counter) or supplements you are taking. If you are Diabetic use insulin, you must adjust the dosage of insulin the day of your upper endoscopy then bring your diabetes medication, if your doctor recommends that you take it after the procedure.

• You will lie on your left side during the procedure.

• Local anaesthetic (pain-relieving medication) may be applied at the back of your throat.

• You will be given a pain reliever and a sedative intravenously (in your vein). You will feel relaxed and drowsy.

• A mouthpiece will be placed in your mouth. It does not interfere with your breathing.

• The doctor will insert the endoscope into your mouth, through your mouth entering into the oesophagus (the food pipe) and into your stomach. The endoscope does not interfere with your breathing.

• Most procedures take 15 to 30 minutes.

• You will stay in a recovery room for about an hour for observation after the procedure.

What are the Indications?

Investigate symptoms: An endoscopy may help your doctor determine what’s causing digestive signs and symptoms, such as nausea, vomiting, abdominal pain, difficulty swallowing and gastrointestinal bleeding.

Diagnose: Your doctor may use an endoscopy to collect tissue samples (biopsy) to test for diseases and conditions, such as anaemia, bleeding, inflammation, diarrhea or cancers of the digestive system.

Treat: Your doctor can pass special tools through the endoscope to treat problems in your digestive system, such as burning a bleeding vessel to stop bleeding, widening a narrow oesophagus, clipping off a polyp or removing a foreign object.

For Healthcare Providers:

Recommendations:

• All Endoscopy sessions will require pre-approval from Nextcare.
• When submitting the claim, kindly provide detailed medical report with the below information:
  • Symptoms with onset and duration.
  • Initial conservative treatment with
  • Abdominal US, Common Bile Duct Stones (CBS), stool analysis.
  • Upper GI endoscopy is generally not indicated for evaluating:
  • Symptoms which are considered functional in origin (there are exceptions in which an endoscopic examination may be done once to rule out organic disease, especially if symptoms are unresponsive to therapy).
  • Metastatic adenocarcinoma of unknown primary site when the results will not alter management.
  • Radiographic findings of:
    • Asymptomatic or uncomplicated sliding hiatal hernia.
    • Uncomplicated duodenal ulcer which has responded to therapy.
    • Deformed duodenal bulb when symptoms are absent or respond adequately to ulcer therapy.
  • Sequential or periodic upper GI endoscopy is generally not indicated for:
• Surveillance for malignancy in patients with gastric atrophy, pernicious anaemia, or prior gastric operations for benign disease.
• Surveillance of healed benign disease such as oesophageal, gastric or duodenal ulcer.
• Surveillance during repeated dilatations of benign strictures unless there is a change in status.
  • Clear indication for endoscopy (refer to indication list below):

Endoscopy under General Anaesthesia (GA):

Diagnostic and uncomplicated therapeutic upper endoscopy and colonoscopy procedures are usually performed with moderate sedation to relieve patient anxiety and discomfort. Indications to perform Endoscopy under General Anaesthesia (GA) are below:

• Patient with previous problems with anesthesia or sedation
• Patient with prescribed or illicit benzodiazepine use
• Alcohol or drug-addicted patients, or patients with an increased tolerance to sedation and analgesic agents (i.e. chronic pain patients treated with opioids),
• Patient undergoing prolonged or complex procedures
• Morbidly obese patients with BMI ≥ 40,
• Patients with documented severe sleep apnea
• Patients younger than 18 years and older than 70 years of age,
• Patients with other documented co-morbid conditions that would prevent safe sedation without anesthesia services (i.e. neurologic conditions such as Parkinson’s, cardiac conditions, uncooperative or combative patients).
• Patient has moderate or severe systemic disease that does not limit the activities (i.e. stable angina or diabetes with systemic sequelae).
• Patient has severe systemic disease that is a constant threat to life (i.e. severe congestive heart failure, end-stage renal disease).
• Recommended CPT codes for the Endoscopy under GA are: 00731-00732 & 00811-00813.

References:

1. https://pubmed.ncbi.nlm.nih.gov/18989141/
2. https://www.webmd.com/heartburn-gerd/guide/upper-endoscopy#1
3. https://www.alfredhealth.org.au/images/resources/referral-guidelines/Endoscopy-Referral-Guidelines.pdf
4. https://www.mayoclinic.org/tests-procedures/endoscopy/about/pac-20395197