Procedure Instructions
 

 

SUPREP Bowel Prep Kit Preparation for Colonoscopy

You will need to pick up or purchase the following at your drugstore:

  • Prescription for SUPREP Bowel Prep Kit

If your current medications include:

  • Iron or iron containing vitamins: discontinue taking these for two days before your examination.
  • Plavis or Coumadin: discontinue taking these for five days before your examination. Verify this is safe with your prescribing physician first. If you are taking Coumadin, blood work must be done the day before. 
  • Heart or blood pressure medications only may be taken by 8 am with a small sip of water. Breathing/inhaler medictions and seizure medications may be taken as directed.
  • Diabetes medication may need to be adjusted during your preparation. Please contact your prescribing physician and follow their instructions.

You must be accompanied by someone to drive you home, as you will be sedated. If  not, the procedure could be cancelled. You will not be allowed to drive for 24 hours after the procedure. If you do so, it will at your own risk!

Day Before Exam:

Do not eat any solid food – follow a clear liquid diet all day. Please follow these instructions, not box instructions. 

You must stay on a clear liquid diet all day. Avoid anything red or purple. Avoid dairy products.

At 6 pm, 

  1. Pour ONE (1) 6 ounce bottle of SUPREP liquid into the mixing container.
  2. Add cool drinking water to the 16-ounce line on the container and mix.
  3. Drink ALL the liquid in the container.
  4. You MUST drink TWO (2) or more 16-ounce containers of water over the next hour.

Afterwards, you may continue to drink clear liquids.

Day of Exam:

Do not eat anything by mouth. No chewing gum, candy, lozenges, or chewing tobacco, etc within 4 hours of your test. Your test will be delayed or cancelled.

6 hours prior to your procedure,

  1. Pour ONE (1) 6 ounce bottle of SUPREP liquid into the mixing container.
  2. Add cool drinking water to the 16-ounce line on the container and mix.
  3. Drink ALL the liquid in the container.
  4. You MUST drink TWO (2) or more 16-ounce containers of water over the next hour.

Afterwards, do not eat or drink anything until your test is completed.

Remember to bring the following with you to the hospital GI Lab:

  • Your insurance card and photo ID
  • A list of medications you are currently taking
  • Completed Health History Form
  • Script from your Primary Care Physician

Due to changes in the insurance guidelines, your Primary Care Physician MUST provide a prescription/order for your procedure. This MUST be faxed to our office PRIOR to your procedure. Our fax number is 724-933-1438.

You may receive bills for physician, pathology (biopsy), facility, anesthesia and/or laboratory services. We can only provide information associated with our fees. Any biopsies taken during your procedure may take 7-10 business days for the results.

Contact your Primary Care Physician for any insurance referrals.

Results and Post-Procedure Instructions will be provided when you are dischared from GI Lab. Due to sedation, you may not remember, hence a responsible adult should be there to listen to these instructions, drive you home and be available to attend to you, if needed.

If you are unable to keep your scheduled appointment, kindly give 48 hours notice.

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Preparation for Colonoscopy

You will need to pick up or purchase the following at your drugstore:

  • Prescription for Nulytely/peg
  • Dulcolax Tablets (2)

If your current medications include:

  • Iron or iron containing vitamins: discontinue taking these for two days before your examination.
  • Plavix or Coumadin: discontinue taking these for five days before your examination. Verify that this is safe with your prescribing physician first. If you are taking Coumadin, blood work must be done the day before. 
  • Heart or blood pressure medications only may be taken by 8 am with a small sip of water. Breathing/inhaler medications and seizure medications may be taken as directed.
  • Diabetes medications may need to be adjusted during your preparation. Please contact your prescribing physician and follow their instructions.

You MUST be accompanied by someone to drive you home, as you will be sedated. If not, the procedure could be cancelled. You will not be allowed to drive for 24 hours after the procedure. If you do so, it will be at your own risk!


Day Before The Exam:

Do not eat any solid food. Follow a clear liquid diet ALL DAY.

It is very important to drink a lot of water. Keep yourself hydrated.

Morning:

Add lukewarm water to the “fill line” on the prep bottle. Put the lid back on the bottle and shake it to dissolve the powder. Put it in the refrigerator so that it can chill. 

4:00 pm:

Take 2 Dulcolax tablets with water. After you take the Dulcolax tablets you may or may not have a bowel movement. Just wait patiently, be sure to use the restroom if you feel the urge to go.

6:00 pm:

Take the prep out of the refrigerator and begin drinking the solution. You need to drink 1 (8 oz) glass every 10 to 20 minutes until you drink 4 (8 oz) glasses. Do not take any medication within 1 hour of drinking the solution. It will get flushed out of your system.


Day of Examination:

On the day of the examination, 6 hours before your examination, drink (within an hour) another 4 (8 oz) glasses of prep solution. Then nothing by mouth* until after the examination.

Afternoon appointment only: If your appointment is scheduled in the afternoon, you may have clear liquids until you drink the other half of the solution that you will drink 6 hours before your examination, then nothing by mouth* until after the examination.

*Nothing by mouth – no chewing gum, candy, lozenges or chewing tobacco, etc within 4 hours of your test. Your test will be delayed or cancelled.

Remember to bring the following with you to the hospital GI Lab:

  • Your insurance cards and photo ID
  • A list of medications you are currently taking
  • Completed Health History Form
  • Script from your Primary Care Physician

Due to changes in the insurance guidelines, your Primary Care Physician MUST provide a prescription/order for your procedure. This MUST be faxed to our office PRIOR to your procedure. Our fax number is 724-933-1438.

You may receive bills for physician, pathology (biopsy), facility, anesthesia and/or laboratory services. We can only provide information associated with our fees. Any biopsies taken during your procedure may take 7-10 business days for the results.

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Screening Colonoscopy

If you scheduled a screening colonoscopy or you think it might be a screening colonoscopy, please follow the following instructions!

**We recommend you check with your insurance company to verify coverage of above procedures.  If a screening is not marked it will be billed as a diagnostic procedure and you will be responsible for co-pays, co insurance and deductibles.**

We must follow the coding policies set up by the Correct Coding Initiative. Your insurance company may pay differently depending upon the procedure code billed. Please contact your insurance company regarding all the information below.

  • Procedure code for screening colonoscopy: G0121 with diagnostic code Z12.11.
  • Procedure code for surveillance colonoscopy with personal history of colon polyps: G0105 with a diagnostic code Z86.010.
  • Procedure code for surveillance colonoscopy with a family history of colon cancer: G0105 with a diagnosis code of Z80.0.
  • Procedure code for surveillance colonoscopy with a personal history of colon cancer: G0105 with a diagnosis code of Z85.038.
  • Procedure code for surveillance colonoscopy with a family history of colon polyps: G0105 with a diagnosis code of Z83.71.

However, if a diagnosis is encountered or lesions/polyps are biopsied and/or removed, your procedure will no longer be considered screening and the following codes must be reported: 45380, 45385, etc. ALSO, if you have ever had polyps or diverticulosis, make sure to tell your insurance company about this as it might alter your coverage and the amount they will cover. Depending on your particular coverage, these charges could be applied to your deductible as it will no longer be considered a screening.

If you have questions, please do not hesitate to contact our office at 724-933-1420 option 2.   Payment plans may be arranged by calling the office, you have deductibles or co insurance payments.

A SCREENING colonoscopy is at age 50, and/or at 10 year intervals, no complaints, no family history of colon cancer or colon polyps.

A SURVEILLANCE/HIGH RISK colonoscopy is done with history of colon cancer, polyps, or primary family history of colon cancer, polyps.  This category undergoes procedures at shortened intervals.

A DIAGNOSTIC colonsocopy is at any age and has complaints such as but not limited to rectal bleeding, abdominal pain, constipation, diarrhea, etc.

Can the physician change, add or delete my diagnosis so that I can be considered a colon screening?  NO!!!  The patient encounter is  documented as a medical record from information you have provided.  It is a binding legal document that cannot be changed to facilitate better insurance coverage.

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Flexible Sigmoidoscopy Instructions

You will need to pick up or purchase the following at your drugstore:

  • One 10 ounce bottle of magnesium citrate
  • Two Fleet enemas

If your current medications include:

  • Plavix or Coumadin: discontinue taking these for 5 days before your examination. First verify that this is safe with your prescribing physician. If you are taking Coumadin, blood work must be done the day before. 
  • Iron or iron contaiing vitamins: discontinue taking these for two days before your examination.
  • Heart or blood pressure medications only may be taken by 8 am with a small sip of water. Breathing/inhaler medications and seizure medications may be taken as directed.
  • Diabetes medications may need to be adjusted during your preparation. Please contact your prescribing physician and follow their instructions.

Day Before Exam:

4:00 pm: Take one 10 ounce bottle of magnesium citrate followed with a clear liquid diet and clear liquids up until midnight.

Morning Appointment: If your appointment is scheduled in the morning, you should have nothing by mouth* to eat or drink after midnight the night before your examination.

Day Of Exam:

Afternoon Appointment: If your appointment is scheduled in the afternoon, you may have a clear liquid breakfast in the morning of your appointment, before 8:00 am, and then nothing by mouth* to eat or drink after that.

Both Morning and Afternoon Appointments: Give yourself one (1) Fleet Enema before going to the hospital on the day of your scheduled appointment (follow the package insert for the directions). If the liquid that returns in the toilet is clear after you have taken (1) Fleet Enema, you do not need to use the second enema. 

Nothing by mouth – no chewing gum, candy, lozenges, or chewing tobacco, etc within 4 hours of test. Your test will be delayed or cancelled.

Remember to bring to following with you to the hospital GI Lab:

  • Insurance cards and photo ID
  • A list of medications you are currently taking
  • Completed Health History Form

You may receive bills for physician, pathology (biopsy), facility, anesthesia and/or laboratory services. We can only provide information associated with our fees. Any biopsies taken during your procedure may take 7-10 business days for the results.

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Capsule Endoscopy Instructions

This procedure involves ingesting a capsule which contains a microscopic camera. It will naturally pass through the digestive system while taking pictures. The images are transmitted to a small computer which saves all the images. It is located in a belt that is worn around your waist. After 7 hours you will return to the doctor’s office and the equipment is taken off. The capsule is disposable and is excreted naturally in your bowel movements. In rare case it will need to be removed endoscopically or surgically.

Discontinue 2 days before: Iron supplements, vitamins, Mylanta, Tums, Milk of Magnesia, and Pepto-Bismol.

The day before the capsule endoscopy – morning: Add lukewarn water to the “fill line” ont he preparation container. Put the lid back on the container and shake to dissolve the powder. Put the container back in the refrigerator so it can chill.

Obtain at your pharmacy: Nulytely and Regian.

  1. The entire day before the exam, stay on a clear liquid diet (see separate sheet).
  2. At 4:00 pm, shake container then drink one liter of Nulytely 4 (8 ounce) glasses.
  3. At 10:00 pm, take one Regian Pill with a small sip of water.
  4. Do not drink anything after 10:00 pm.

Day of capsule endoscopy:

  1. Take one Regian pill at 5:00 am with a small sip of water.
  2. Arrive wearing loose fitting, elastic waist, two-piece clothing. Refrain from having zippers, buttons, and belts on your clothing.
  3. At your doctor’s office, you will be asked to sign a consent form.
  4. You will be connected to a small computer which you will wear in a belt around your waist. 
  5. Ingestion of the capsule.

After ingesting the capsule:

Limit the use of computers, cell phones and electronics.

  1. After ingesting the pill, do not drink for 2 hours. After 4 hours, you may have a light lunch. After the exam, you may return to your normal diet. Contact the office if you have any abdominal pain, nausea or vomiting during the exam.
  2. Until the capsule is excreted, do not be near any powerful electromagnetic fields (MRI’s). 
  3. The capsule endoscopy lasts for 7 hours and is complete according to your doctor’s instructions. DO NOT disconnect the equipment or remove the belt at any time during the exam. 
  4. During the exam, verify that the green light at the top of the computer is flashing. If not, call the office.

After completing the capsule endoscopy

  1. Return to the office at approximately 2:00 pm to have the equipment removed.
  2. After 2 weeks, you will be asked to do an x-ray to verify the capsule has been exreted if you have not passed the capsule in the bowel movements.
  3. Do not undergo an MRI until it is verified the capsule has passed.

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Endoscopic Ultrasound Instructions

If your current medications include:

  • ANTICOAGULANT/BLOOD THINNERS: discontinue taking these for THREE days before your procedure and up to THREE DAYS after your procedure. Verify that this is safe with your prescribing physician first. If you are taking Coumadin, blood work must be done the day before. 
  • Heart or blood pressure medications only may be taken by 8 am with a small sip of water. Breathing/inhaler medications and seizure medications may be taken as directed.

You MUST be accompanied by someone to drive you home, as you will be sedated. If not, the procedure could be cancelled. You will not be allowed to drive for 24 hours after the procedure. If you do so, it will be at your own risk.

Morning Appointment: You should have nothing by mouth* to eat or drink after midnight the night before your scheduled appointment. 

Afternoon Appointment: You may have a clear liquid breakfast, before 8:00 am, the morning of your scheduled appointment and then nothing by mouth to eat or drink after that.

*Nothing by mouth – no chewing gum, candy, lozenges or chewing tobacco, etc within 4 hours of your test. Your test may be delayed or cancelled.

It is possible you may receive oral antibiotics after your procedure. Please inform the nursing staff if you have any medication allergies.

Remember to bring the following with you to the hospital GI Lab:

  • Your insurance cards and photo ID
  • A list of any medications you are currently taking
  • Completed Health History Form

You may receive bills for physician, pathology (biopsy), facility, anesthesia and/or laboratory services. We can only provide information associated with our fees. Any biopsies taken during your procedure may take 7-10 business days for the results.

Post-Procedure Instructions will be provided when you are discharged from the GI Lab. Due to sedation you may not remember; hence a responsible adult should be there to listen to these instructions, drive you home and be available to attend to you, if needed.

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Panendoscopy or EGD Instructions

If your current medication include:

  • Plavix or Coumadin: discontinue taking these for five days before your examination. Verfiy that this is safe with your prescribing physician first. If you are taking Coumadin, blood work must be done the day before.
  • Heart or blood pressure medications only may be taken by 8 am with a small sip of water. Breathing/inhaler medications and seizure medications may be taken as directed.

You MUST be accompanied by someon to drive you home, as you will be sedated. If not, the procedure could be cancelled. You will not be allowed to drive for 24 hours after the procedure. If you do so, it will be at your own risk!

Morning Appointment: You should have nothing by mouth* to eat or drink after midnight the night before your scheduled appointment. 

Afternoon Appointment: You may have a clear liquid breakfast, before 8:00 am, the morning of your scheduled appointment and then nothing by mouth* to eat or drink after that.

*Nothing by mouth – no chewing gum, candy, lezenges or chewing tobaco, etc within 4 hours of your test. Your test may be delayed or cancelled.

Remember to bring the following with you to the hospital GI Lab:

  • Your insurance cards and photo ID
  • A list of any medications you are currently taking
  • Completed Health History Form

Post-Procedure Instructions will be provided when you are discharged from the GI Lab. Due to sedation you may not remember; hence a responsible adult should be there to listen to these instructions, drive you home and be available to attend to you, if needed.

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PEG Instructions

If your current medications include:

  • Plavix or Coumadin: discontinue taking these for five days before your examination. Verify that this is safe with your prescribing physician first. If you are taking Coumadin, blood work must be done the day before.
  • Heart or blood pressure medications only may be taken by 8 am with a small sip of water. Breathing/inhaler medications and seizure medications may be taken as directed.

You must be accompanied by someone to drive you home, as you will be sedated. If not, the procedure could be cancelled. You will not be allowed to drive for 24 hours after the procedure. If you do so, it will be at your own risk!

Morning Appointment: You should have nothing by mouth* to eat or drink after midnight the night before your scheduled appointment.

Afternoon Appointment: You may have a clear liquid breakfast before 8 am, the morning of your scheduled appointment and then nothing by mouth* to eat or drink after that.

*Nothing by mouth – no chewing gums, candy, lozenges or chewing tobacco, etc within 4 hours of your test. Your test may be delayed or cancelled. 

Remember to bring the following with you to the hopital GI Lab:

  • Your insurance cards and photo ID
  • A list of any medications you are currently taking
  • Completed Health History form

You may receive bills for physician, pathology (biopsy), facility, anesthesia and/or laboratory services. We can only provide information associated with our fees. Any biopsies taken during your procedure may take 7-10 business days for the results.

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ERCP Instructions

If your current medications include:

  • Plavix or Coumadin: discontinue taking these for five days before your examination. Verify that this is safe with your prescribing physician first. If you are taking Coumadin, blood work must be done the day before.
  • Heart or blood pressure medications only may be taken by 8 am with a small sip of water. Breathing/inhaler medications and seizure medications may be taken as directed.

You must be accompanied by someone to drive you home, as you will be sedated. If not, the procedure could be cancelled. You will not be allowed to drive for 24 hours after the procedure. If you do so, it will be at your own risk!

Morning Appointment: You should have nothing by mouth* to eat or drink after midnight the night before your scheduled appointment.

Afternoon Appointment: You may have a clear liquid breakfast before 8 am, the morning of your scheduled appointment and then nothing by mouth* to eat or drink after that.

*Nothing by mouth – no chewing gums, candy, lozenges or chewing tobacco, etc within 4 hours of your test. Your test may be delayed or cancelled. 

Remember to bring the following with you to the hopital GI Lab:

  • Your insurance cards and photo ID
  • A list of any medications you are currently taking
  • Completed Health History form

You may receive bills for physician, pathology (biopsy), facility, anesthesia and/or laboratory services. We can only provide information associated with our fees. Any biopsies taken during your procedure may take 7-10 business days for the results.

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Urea Breath Test Instructions
  1. Two weeks prior to breath test, stop all anti-reflux medicine. Examples include Nexium, Protonix, Zegerid, Tums, Mylanta, Pepto-Bismol. If unable to stop medicines, please call the office to discuss with your doctor.
  2. One hour prior to breath test, have nothing by mouth.
  3. Arrive at appointment time. There’s no need to arrive early.

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