Frequently Asked Questions
Endoscopy is a medical procedure that involves the use of an endoscope to examine the interior of a hollow organ or cavity of the body. It's a general term that covers many types of endoscopic procedures.
Endoscopy is a broad term for any procedure using an endoscope. EGD, or esophagogastroduodenoscopy, is a type of endoscopy that looks at the upper part of the gastrointestinal tract, including the esophagus, stomach, and duodenum. Colonoscopy is another type of endoscopy that examines the colon (large intestine).
Your primary care physician may ask you to see a gastroenterologist for many reasons. Gastroenterologists are experts in diagnosing and treating patients for symptoms that arise from the organs of the gastrointestinal tract, including the esophagus, stomach, large and small bowels, pancreas, liver, and gallbladder. Examples of such symptoms could include diarrhea, constipation, trouble swallowing, heartburn, or abdominal pain. They also perform screening or surveillance colonoscopy for patients with a family history of colon cancer or personal history of colon polyps. SWGA physicians have taken at least three years of training in Internal Medicine, have passed board examinations, and have taken at least two additional years of training in digestive disease.
Your first visit to Southwest Gastroenterology will allow your gastroenterologist to evaluate your symptoms. As part of that consultation, your gastroenterologist may request additional tests or procedures such as blood tests, imaging studies, or endoscopic examinations for diagnosis or treatment. A treatment plan may also be prescribed along with a follow-up plan of care. Sometimes, follow-up may be through your primary care physician.
You may schedule an appointment for any of the SWGA physicians by calling (505) 999-1600. Your first visit will be an office visit only. No procedures will be done at this time. However, our Endoscopy Center offers Open Access Colonoscopy services for healthy, age-appropriate patients to easily schedule a colonoscopy. In most cases, this does not require a pre-procedure visit. This will help you save time and money.To see if you qualify to schedule through Open Access, please complete an intake form. You can always call us with questions at 505-999-1600. Please provide us with 24-hour notice if you are unable to keep an appointment. We have a long wait for appointments, and this courtesy allows other patients who are waiting for an appointment to be scheduled sooner.
You will be asked to complete a SWGA registration form and a personal/social history form and return them at the time of your first visit. This will help expedite the registration process.
It is also important that you bring the following items with you:
Insurance card/Referral documents
Recent blood work and x-rays ( upper GI series, barium enema, ultrasound, or CT scans of the abdomen or pelvis)
Copies of past medical records
Note: If medical records are to be sent by your doctor(s), please call us to verify that we have received them prior to your visit. Lack of these items can result in delays and/or your appointment being rescheduled.
If you are experiencing a medical emergency, Dial 911 on your telephone immediately or go to the nearest emergency room.
Follow-up care is an important part of your treatment plan. SWGA has a system designed to notify you when you are due for follow-up care such as an office visit or a procedure. When you receive your notification, please contact our office at (505) 999-1600 to schedule your next appointment.
Southwest Gastroenterology Associates, P.C. works with Lovelace hospital, among others. If you need to be hospitalized, this is the facility that will be utilized. A SWGA gastroenterologist will usually see you on a daily basis.
Every effort is made to collect the correct copay/deductible at the time of service. Physicians services for procedures are billed to the patient after insurance pays. Please note you will receive only one statement for any patient balance due. If not paid within 30 days, the account will be considered for collections unless arrangements have been made with our office. Visa and Mastercard are accepted. Patient share or co-pays will be collected at the time of service. SWGA is prohibited by law from waiving or discounting co-pays, coinsurance or deductible payments required to be made by the patient under their health insurance plan. This prohibition includes so-called “professional courtesy” discounts. If you have circumstances where financial arrangements need further discussion, please contact our business office prior to your appointment time at (505) 999-1600 SWGA will file Medicare or other insurance claim forms as a courtesy for you. The patient is responsible for deductibles, co-payments and any remaining balances after insurance payment at the time of service.
Should your SWGA physician schedule you for an outpatient procedure such as an endoscopy or colonoscopy, you can expect to incur charges from possibly three sources:
Physician professional fee, processed through our office
Pathologist, processed through the lab used to examine biopsy specimens, if any are obtained
Hospital or ambulatory surgery center fee, processed where the procedure will be performed
Please be prepared to pay your co-pay, co-insurance, or deductible on the day of your procedure. We will file the physician and hospital charges with your insurance company. We encourage you to speak with our billing office should you have questions or concerns.
When you call for prescription refills, you will be transferred to a medical assistant’s voice mail. Prescription refills can best be handled during office hours (8:00 a.m. to 5:00 p.m., Monday through Friday) when your chart is available and the gastroenterologist who knows you best can be contacted. When you call for a refill, please have the name of your medication, the dose, the dosing schedule, the prescription number, the phone number and name of the pharmacy at which you want the prescription to be refilled.
We rarely schedule patients for endoscopies or biopsies without consultation first. We believe a thoughtful consideration of your problem and full discussion of the risks and benefits of any test are mandatory before setting up a procedure. Visa and Mastercard are accepted.
Most insurance plans require an authorized referral prior to each visit. You will need to contact your primary care physician prior to making an appointment to obtain a referral for your appointment. Referrals must be validated by your insurance company and be in their system in order to be valid. Referrals can be mailed, faxed or called into our office. Keep in mind referrals can take up to 10 working days to be processed. It is the patient’s responsibility to have the proper referral at the time of their visit. If you arrive at our office without a referral, you will have to either pay in full at the time of service or reschedule your appointment.
Procedure Specific Questions
The cleaner your colon is, the safer and more complete your exam. If your colon is not well cleaned out, your doctor may have to qualify your results by saying, “Well, I didn’t see any polyps, but I couldn’t see every surface”. If your prep is quite unsatisfactory, your doctor may recommend you reschedule another colonoscopy (with another prep). It is therefore very much in your best interest to try to follow your prep instructions as best as possible.
Some time is required before the procedure starts for changing into a gown, getting your IV started, answering nursing questions, last minute trips to the bathroom, etc.
Some patients experience some crampy abdominal pain caused by advancement of the scope around turns in the colon, but this is minimized by the sedation you will receive.
The most common reason for having a colonoscopy is to detect and remove polyps. Polyps are small mushroom- like growths of the colon lining. They are significant because almost all colon cancers start off as polyps, and having polyps removed can reduce the risk of developing colon cancer. Most, but not all, polyps can be removed at the time of colonoscopy. No one knows exactly what causes polyps to grow. It is not thought to be significantly related to diet or other environmental factors, and mostly reflects genetic susceptibility and the effects of aging. If the doctor removes polyps, they will be sent to the lab where a pathologist will examine them under the microscope. Your doctor will then send you a letter or call you regarding the results of this pathology exam.
It varies from person to person, but ranges from 4 to 6 feet.
Diverticula are small-pocket like sacs in the wall of the bowel. Anatomically speaking, they are actually herniations of the inner bowel lining out through the bowel’s muscle layer. They are thought to develop over time from muscular squeezing by the colon wall. They are not growths and have no pre-cancerous potential. They are extremely common, especially in people over age 50. They rarely cause problems but occasionally get infected (called diverticulitis) or bleed. A high fiber diet keeps diverticular disease well managed.
Yes. You might feel wide awake immediately after the procedure is completed. Your doctor will visit you in the recovery room after your procedure is completed and review your results with you, as well as any special instructions and plans for future care or tests.
Generally yes. However, if any polyps are removed, you should not take any non-steroidal medicines for 2 weeks after the procedure. Non-steroidals are pain and arthritis medicines such as aspirin, Motrin, ibuprofen, Advil, Aleve, etc. This includes baby aspirin. If you usually take a prescribe blood thinner, you should discuss when to restart it when you speak to the doctor in the recovery room.
You can eat when you get home. But you should start slowly and avoid greasy or fatty food for your first meal.
Due to the sedation given during the procedure, you should plan to rest at home for the remainder of the day. You may resume your usual activities the day after your procedure.
Due to the sedation given during the procedure, you are considered legally impaired. The sedation medication impairs your judgment and reflexes. You will not be permitted to drive for 12 hours following your procedure.
No, due to the sedation given during the procedure, you are considered legally impaired. The sedation medication impairs your judgment and reflexes. A trusted person must be with you to drive you home or accompany you on public transit.
Open-Access simply refers to the easy access to a routine screening colonoscopy based on health factors. With Open-Access, the initial office visit with the doctor is eliminated and only a brief summary is provided following the colonoscopy procedure. There is no difference in procedure itself. Open-Access service is designed—and guided by Medicare and medical insurers—to save the doctor’s time for qualifying patients, while the patient benefits by saving a co-pay/office visit fee. Some Open-Access patients elect to have an in-depth consultation with the doctor, in which case, an office visit may be scheduled. However, the Open-Access qualifying patient should expect to cover costs of this visit as it will not be covered by medical insurance. Patients with significant illnesses—poorly controlled diabetes, significant cardiac disease, severe breathing problems, kidney problems—are required to schedule an office visit prior to the procedure and are not eligible for the Open-Access service. Also, if symptoms are present, such as underlying abdominal pain, changes in bowel habits, or any other gastrointestinal issues, an Open-Access Colonoscopy will not be the best initial procedure. In this case as well, a regular office visit should be scheduled
This is actually a common occurrence. Often member service representatives will tell a patient that if only the physician coded it with a “screening” diagnosis if would have been covered at 100%. However, further questioning of the representative will reveal that the “screening” diagnosis can only be amended if it applies to the patient. Remember, many insurance carriers only consider a patient over the age of 50 with no personal or family history as well as no past or present gastrointestinal symptoms as a “screening” (V76.51 ).
If you are given this information, please document the date, name, and phone number of the insurance representative. Next, contact our billing department who will perform an audit of the billing and investigate the information given. Often the outcome results in the insurance company calling the patient back and explaining that the member services representative should never suggest a physician change their billing to produce
No. The patient encounter is documented as a medical record from information you have provided as well as an evaluation and assessment from the physician. It is a binding legal document that cannot be changed to facilitate better insurance coverage. Patients need to understand that strict government and insurance company documentation and coding guidelines prevent a physician from altering a chart or bill for the sole purpose of coverage determination. This is considered insurance fraud and punishable by law.
However, if a patient notices an error in the medical record (e.g. date of birth, medication dosage, history notation, etc), he/she may request a correction/amendment.
Call Southwest Endoscopy billing department at 505-999-1600 with any questions or concerns. They are a great source of information and are happy to help if you are struggling to understand your financial obligations. However, it is still necessary for you to first call your insurance company and ask the above questions.
You may receive bills from separate entities associated with your procedure, such as the physician, facility, anesthesia, pathologist, and/or laboratory.