Colonoscopy

Colonoscopy is a procedure where an instrument is used to examine the inside or lining of the colon. A colonoscope is a long, flexible fibre-optic instrument with a light source and camera at its tip. It is passed through the anus and guided around the colon. The procedure is performed in a day surgery unit under sedation or sometimes, full general anaesthesia. On the days prior to the colonoscopy the bowel must be prepared so it is necessary to have a clear liquid diet and to drink a laxative solution. This solution will produce dramatic diarrhoea and thereby empty out the bowel.

During the procedure, the lining of the bowel is closely inspected. Any abnormalities can be photographed, biopsied if appropriate and some lesions, such as polyps, can often be completely removed.

Like any procedure, colonoscopy is accompanied by some risks and side effects – but overall these are uncommon. They can be associated with the preparation, including nausea and vomiting, and sometimes a headache or dizziness related to dehydration. There can also be side effects from the anaesthetic or medications used for sedation.

If polyps are removed or biopsies are taken there is a small chance of bleeding which can occur 1-2 weeks after the procedure. The most serious risk is perforation of the colon. This usually requires hospitalisation, antibiotic treatment and possible bowel surgery.

Patients with a family history of bowel cancer, or a personal history of inflammatory bowel disease or polyps, may require regular screening with colonoscopy. Any patient with symptoms such as a persisting alteration in bowel function or rectal bleeding should be seen by a doctor to assess the need for colonoscopy.

Virtual Colonoscopy – CT Colonography

This can be an alternative to colonoscopy in situations where colonoscopy may be too risky or otherwise inappropriate.

As with normal colonoscopy, a bowel preparation is needed although this is often not as aggressive as before a colonoscopy. A fine catheter is then inserted into the anus and the colon distended with carbon dioxide. A CT scan is then performed with the patient lying both on their back and on their abdomen. These two sets of scans are then combined to make a composite image of the lumen of the bowel.

Although a good diagnostic test, unfortunately therapeutic interventions cannot be performed as a part of this procedure and abnormal findings need to be appropriately followed up.

Colonoscopy Referrers

On 1st November 2019, Medicare introduced 8 new item numbers for colonoscopies. These replace the previous 2, and all but one of the new numbers has quite strict descriptors or qualifying criteria related to that item number.

From now on, it is imperative that in referring a patient for a colonoscopy, the referral contains sufficient information regarding:
1) Symptoms – +ve FOB, documented anaemia or iron deficiency, abnormal radiology, known or suspected inflammatory bowel disease or “symptoms consistent with pathology of the colonic mucosa”, or
2) The specific family history of colorectal malignancy, the date of the previous colonoscopy and the histology of any previous polyps removed (if procedure not done by Dr Henry Hicks).

…Otherwise, the procedure may not be funded by Medicare. This non-funding status will be independent of the venue at which the procedure will be performed, either private or public.

We ask that you make yourself familiar with the various criteria of the new item numbers as this will allow your patients to continue to be managed in a timely manner, no matter where they have their procedure.

The new item numbers (32222-32229) can be viewed on the Department of Health website or at mbsonline.gov.au or gesa.org.au.

If there are still concerns, our rooms will hopefully be able to sort these out for you.

Do you have any questions?