# Colonic evacuation



## cynthiar (Jan 10, 2008)

What if a gastroenterologist that does colonoscopies, offers to patients, a relaxing room with music and candles, and then does a colonic evacuation before the colonoscopy.  Can we charge for the evacation? The physician is not doing this procedure. Some patients cannot tolerate the liquid or the pills and would love to have an easier prep?
If this is something that is included in the global fee of the colonoscopy, can we bill the patient for this?  There are patients who would rather have this prep.


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## KimmHall (Jan 10, 2008)

*colonic Evacuation*

This is the first time I have heard of this (colonic evacuation). Can you explain in a little more detail what this is? It sounds interesting. Also there are no global days on a colonoscopy, but once you give me a little more detail i would be happy to check into it even further


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## cynthiar (Jan 11, 2008)

car47 said:


> What if a gastroenterologist that does colonoscopies, offers to patients, a relaxing room with music and candles, and then does a colonic evacuation before the colonoscopy.  Can we charge for the evacation? The physician is not doing this procedure. Some patients cannot tolerate the liquid or the pills and would love to have an easier prep?
> If this is something that is included in the global fee of the colonoscopy, can we bill the patient for this?  There are patients who would rather have this prep.



It really is basically an enema, but in very pleasant surroundings,spa like, and the few patients that have had this right before the colonoscopy, loved it. They were not up all night from the prep.  The physician states the patients were cleaner than the liquid or pill prep.


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## sundaey (Mar 6, 2008)

*evacuations*

my docs have their patients do a liquid diet the day before, and use the fleet's enema at noon the day prior to the scope.
It sounds like your patients are being lazy, really, and my docs would laugh hysterically!


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## k-jag (Mar 8, 2008)

I've never seen anything from any carrier that considers the use of music and candles as medically necessary (not even here in California!) 

I think we can all agree that a colonoscopy bowel prep is not anyone's favorite thing to do, and it is usually only a one day regimen.  Many of our colonoscopy patients are Medicare age and almost all of them are capable of completing a standard bowel prep themselves or with the help of their family/caregiver.  On rare occasion (because of blindness, paralysis, or mental incapacity) carriers have covered a Home Health Nursing Visit to help with prep.  

It would be a real stretch to try and get paid from a Medicare carrier for what is essentially an enema.  I guess if you wanted to try and get paid directly from the patient for this unconventional prep, you could have them sign an ABN waiver, but I don't think it's a good idea.  Medicare will protect their beneficiaries from what they may perceive as unnecessary non-covered expenses.  A cash-paying patient is a different story; you could charge them for the extra service, but I would definitely document that you informed them of the standard home-based prep and the fact that they have a choice of prep regimen.


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## codegirl0422 (Mar 8, 2008)

I agree. With Medicare, this would not count as medical necessary. You could try using a ABN form, but I still think you at risk, like stated below, Medicare will protect their beneficiaries from what they may perceive as unnecessary non-covered expenses. Our area's other biggest carrier, BCBS would not find this as medical necessary. Just my opinion, bowel prep comes along with any colonoscopy, no matter how it is done. And seems to me it would be global with the procedure. 

If it was going to be done, I would definitely come up with a document that informs the patient of the standard home-based prep and this prep, including the cost to the patients, letting the patient know they have a choice. If your practice as a lawyer, you could have them review it.



kerrijag said:


> I've never seen anything from any carrier that considers the use of music and candles as medically necessary (not even here in California!)
> 
> I think we can all agree that a colonoscopy bowel prep is not anyone's favorite thing to do, and it is usually only a one day regimen.  Many of our colonoscopy patients are Medicare age and almost all of them are capable of completing a standard bowel prep themselves or with the help of their family/caregiver.  On rare occasion (because of blindness, paralysis, or mental incapacity) carriers have covered a Home Health Nursing Visit to help with prep.
> 
> It would be a real stretch to try and get paid from a Medicare carrier for what is essentially an enema.  I guess if you wanted to try and get paid directly from the patient for this unconventional prep, you could have them sign an ABN waiver, but I don't think it's a good idea.  Medicare will protect their beneficiaries from what they may perceive as unnecessary non-covered expenses.  A cash-paying patient is a different story; you could charge them for the extra service, but I would definitely document that you informed them of the standard home-based prep and the fact that they have a choice of prep regimen.


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