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Performing EGD and colonoscopy procedures on the same day
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Patients who have unexplained anemia due to blood loss or other reasons often
undergo two diagnostic endoscopic procedures: esophagogastroduodenoscopy (EGD)
and colonoscopy. These two procedures can be safely performed together on the
same day.
Performing these endoscopic procedures on the same day offers several important
advantages to our members:
Safety. Patients are only administered one dose of anesthesia, rather than two.
Convenience. For patients who are actively employed, they will only need to
miss one day of work rather than two. In addition, they only need to arrange
once for help with transportation to and from the office and with child care,
if applicable. Finally, patients will only have to prepare once for the
procedures.
Cost-savings. Members who have these two procedures on the same day are only
required to pay cost-sharing (i.e., copayment, deductible, or coinsurance)
once. Members who get these procedures on separate dates of service will pay
cost-sharing twice.
In addition to affording advantages to our members, performing these endoscopic
procedures on the same day also helps reduce health care costs, as the
procedures performed on the same day are paid as one facility charge and one
anesthesia charge.
Hashem B. El-Serag, MD, chief of gastroenterology and hepatology at Baylor
College of Medicine, led a research effort to analyze nearly 13,000 Medicare
beneficiaries who underwent both a colonoscopy and EGD within 180 days of one
another.1 Sixty-three percent of the procedures were performed on
the same day, or "bundled." However, procedure bundling was not used for 37
percent of the beneficiaries. Among these unbundled procedures, 20 percent were
performed within 30 days of each other. Even more notable, nearly 30 percent of
the unbundled procedures were performed within four days of one another. There
were no significant differences with regard to gender or age between the three
groups of patients (i.e., those who had bundled procedures, those who had them
within 30 days, and those who had them within 31-180 days).
Dr. El-Serag concluded that performing these procedures on the same day "is
likely to reduce the overall costs to the health care system by saving the
facility fees, anesthesia, and work days lost."2
The majority of IBC-participating providers are correctly performing these
procedures; however, there is a concern with those providers who regularly
perform these services on different dates of service. In most cases, this
behavior will present an unnecessary safety risk, as well as additional
inconvenience and cost, to our members. Whenever medically appropriate, we
encourage our network providers to perform these endoscopic procedures on the
same date of service for those patients with indications for both procedures.