What’s the difference between a screening and a diagnostic colonoscopy?
Screening colonoscopies and diagnostic colonoscopies are performed using
the same equipment. The difference is how the procedure is billed to your
insurance. Billing will depend on your symptoms (or lack of symptoms)
and what your doctor finds during the procedure.
A colonoscopy is considered a preventive screening if the patient doesn’t
have any gastrointestinal symptoms and no polyps or masses are found during
the colonoscopy.
The Affordable Care Act (ACA) considers preventive services “essential
health benefits” and requires insurance companies to pay all associated
costs. That also means you won’t have to pay a copay or coinsurance
for a screening colonoscopy.
Since a diagnostic colonoscopy isn’t considered preventive, your
insurance may require you to pay a copay or coinsurance.
Screening Colonoscopy
A colonoscopy is considered screening when:
You’ve had no lower gastrointestinal signs or symptoms before the
colonoscopy
No polyps or masses are found during the colonoscopy
There’s no family history of polyps or colon cancer
You have no history of polyps or colon cancer
Diagnostic Colonoscopy
A colonoscopy is considered diagnostic when you’ve had:
Signs or symptoms in the lower gastrointestinal tract noted in your medical
record before the procedure, including:
Abdominal pain that doesn’t improve
Anemia
Change in bowel habits
Constipation
Diarrhea
Rectal bleeding
Blood in the stool
Polyps within the past 10 years
Abdominal pain that doesn’t improve
A positive stool-based test or CT colonography and require a follow-up
colonoscopy
Can Screening Become Diagnostic?
It’s true that you may go in for a screening colonoscopy and come
out with a diagnostic colonoscopy. If your doctor finds a mass needing
biopsy or finds a polyp, your colonoscopy is considered diagnostic at
that point. That’s why it’s essential to understand your insurance
coverage before your procedure.
