Billing Questions
Bowel Preparation for Colonoscopy
Endoscopy / Procedures
Physician / Office / Miscellaneous

Billing

Please call our office at (317) 872-1161 for an approximate cost. We are unable to determine an exact cost until after the procedures which are modified by interventions such as biopsy, polyp removal, dilations, etc. In addition, be mindful that you will also be billed by the endoscopy facility / hospital as well as other departments such as radiology and pathology if their services are utilized.

You may receive bills from your specialist, the endoscopy facility, radiology and pathology. If you have questions about these bills or how they were processed by your insurance company, contact the number specified on that bill.

There is no guarantee of payment by your insurance company. It is important that you call your insurance company directly to determine your coverage, benefits and deductibles as they apply to your specific diagnostic or screening procedure. Our office contacts your insurance company only to determine if prior authorization is required.

Prior authorization may be required by your insurance. It is the prior notification of testing which authorizes services and payment at the highest level of benefits. This will often lower the amount of out of pocket expense to you.

Yes. We accept monthly payments that fit your budget on all accounts. No interest or finance charges will be applied. We accept payment in the form of check, money order, Visa or MasterCard. Feel free to call our office to make your credit card payment at (317) 872-1161.

Please call our office at (317) 872-1161 for the codes that will be used for your specific procedure.

We do network with most insurance companies. Please contact your insurance company directly to check whether we are in your network or not.

Please contact our office at 317-872-1161 for further information regarding our Self Pay Policy.

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Bowel Preparation for Colonoscopy

Examples of clear liquids include strained fruit juices, water, clear broth or bouillon, coffee or tea (without milk or creamer), Gatorade, carbonated and non-carbonated soft drinks, Kool-aid, plain jello or popsicles. We do ask that you avoid red or purple liquids.

We strongly discourage the use of alcohol both the day before and day of your procedure. Alcohol is a diuretic which can cause excessive fluid losses and dehydration which can precipitate kidney failure. In addition, it can be a lethal combination with the sedatives that you will receive for your procedure as a result of excessive or prolonged sedation.

You may notice bloating or cramping at the beginning of the bowel prep, but this usually gradually improves once the diarrhea begins. Occasionally, some may develop nausea with vomiting. The best remedy for this is to take a break from the prep for a half an hour or hour to allow it to move downstream, and then resume drinking at a slower rate. Many have found that drinking the prep through a straw and chilling the solution improves tolerance. In addition, most importantly listen to your body. Finally, it is also worthwhile to get a supply of aloe wet wipes and Desitin ointment to ward off a sore bottom.

Individual responses to laxatives do vary. The prep often works within 30 minutes; but may take as long as 3 hours. Please remain within easy reach of toilet.

The stool should be watery in consistency. It does not have to be clear in color like water since digestive juices will continue to tint the stool yellow and small flecks of debris are not a problem as long as the stool is not muddy or thick. If you are concerned that your prep has not been effective please inform the nurse during pre-operative check-in as well as the physician as this may save you the cost of an incomplete attempted examination.

Medications taken at least an hour before beginning the prep should be adequately absorbed, but thereafter, they are likely to be washed away by the prep.

The Food and Drug Administration (FDA) now requires the manufacturer of Osmoprep® (“pill” prep) to add a boxed warning due to the risk of kidney failure. Although rare, patients have developed kidney failure requiring dialysis. For this reason we encourage all patients to use a non “pill” prep. However, if you are completely healthy, under the age of 55 and are not using any medications (including OTC arthritis medications excluding Tylenol) that affect kidney function or perfusion you may request this prep. We also ask that you read the FDA alert. It is also important to understand that the volume of fluid taken with Osmoprep® is no different than many of the current non “pill” preps.

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Endoscopy / Procedures

After your pre-operative assessment and IV placement, you will be taken to a private endoscopy suite. The licensed nurse will pace on your equipment that monitors your heart rhythm, oxygen status and blood pressure. You will receive supplemental oxygen through a nasal cannula (clear tubing that fits just under your nose). After you have spoken to the physician you will roll on your left side. The sedatives will then be administered. Once you are sedated the procedure will be performed. You should be comfortable and unaware of the actual procedure itself. In fact, most patients will sleep through their procedure. Once the procedure is complete you will be taken to recovery. The physician will complete your discharge forms and dictate a letter to your primary care or referring physicians. Before discharge home the physician will speak to your driver unless you request otherwise.

You may observe a dry mouth, drowsiness, gassiness and hunger. The dry mouth and drowsiness are from the sedation and will gradually wear off. The gassiness is from the air that was placed into your digestive tract during the procedure. This allows the physician to see the esophagus, stomach, small intestine and colon well. Some air is removed at the completion of the exam and the remainder will pass naturally.

Once you wake up in recovery the nurse will offer you some juice. After you return home you may have a light breakfast or lunch. Listen to your body and eat what it desires. However, go slow and use some common sense.

Fortunately, complications are exceedingly rare. However, nearly all physicians who perform invasive procedures have had or will have complications. Complications with endoscopy include bleeding, infection, reaction to medications, perforation (hole in bowel wall), injury to other organs (pancreas, spleen, liver), kidney failure, lung failure, cardiac arrest or death. In addition, endoscopy is not a perfect science or 100% accurate and therefore abnormalities may not be seen. For example, mammograms and PSA blood testing do to always detect breast or prostate cancer when present, respectively.

Colonoscopy is a procedure used to see inside the colon and rectum. Colonoscopy can detect inflamed tissue, ulcers, and abnormal growths. The procedure is used to look for early signs of colorectal cancer and can help doctors diagnose unexplained changes in bowel habits, abdominal pain, bleeding from the anus, and weight loss.

The doctor usually provides written instructions about how to prepare for colonoscopy. The process is called a bowel prep. Generally, all solids must be emptied from the gastrointestinal tract by following a clear liquid diet for 1 to 2 days before the procedure.

During colonoscopy, patients lie on their left side on an examination table. In most cases, a light sedative, and possibly pain medication, helps keep patients relaxed. Deeper sedation may be required in some cases. The doctor and medical staff monitor vital signs and attempt to make patients as comfortable as possible.

The doctor inserts a long, flexible, lighted tube called a colonoscope, or scope, into the anus and slowly guides it through the rectum and into the colon. The scope inflates the large intestine with air to give the doctor a better view. A small camera mounted on the scope transmits a video image from inside the large intestine to a computer screen, allowing the doctor to carefully examine the intestinal lining. The doctor may ask the patient to move periodically so the scope can be adjusted for better viewing. Once the scope has reached the opening to the small intestine, it is slowly withdrawn and the lining of the large intestine is carefully examined again. Bleeding and puncture of the large intestine are possible but uncommon complications of colonoscopy.

A doctor can remove growths, called polyps, during colonoscopy and later test them in a laboratory for signs of cancer. Polyps are common in adults and are usually harmless. However, most colorectal cancer begins as a polyp, so removing polyps early is an effective way to prevent cancer.

The doctor can also take samples from abnormal-looking tissues during colonoscopy. The procedure, called a biopsy, allows the doctor to later look at the tissue with a microscope for signs of disease.

The doctor removes polyps and takes biopsy tissue using tiny tools passed through the scope. If bleeding occurs, the doctor can usually stop it with an electrical probe or special medications passed through the scope. Tissue removal and the treatments to stop bleeding are usually painless.

Colonoscopy usually takes 30 to 60 minutes. Cramping or bloating may occur during the first hour after the procedure. The sedative takes time to completely wear off. Patients may need to remain at the facility for 1 to 2 hours after the procedure. Full recovery is expected by the next day. Discharge instructions should be carefully read and followed.

Routine colonoscopy to look for early signs of cancer should begin at age 50 for most people-earlier if there is a family history of colorectal cancer, a personal history of inflammatory bowel disease, or other risk factors. The doctor can advise patients about how often to get a colonoscopy.

EGD stands for esophagogastroduodenoscopy also known as upper endoscopy. Upper endoscopy enables the physician to look inside the esophagus, stomach, and duodenum (first part of the small intestine). The procedure might be used to discover the reason for swallowing difficulties, nausea, vomiting, reflux, bleeding, indigestion, abdominal pain, or chest pain.

For the procedure you will swallow a thin, flexible, lighted tube called an endoscope. You will receive pain medicine and a sedative to help you relax during the exam. The endoscope transmits an image of the inside of the esophagus, stomach, and duodenum, so the physician can carefully examine the lining of these organs. The scope also blows air into the stomach; this expands the folds of tissue and makes it easier for the physician to examine the stomach.

The physician can see abnormalities, like inflammation or bleeding, through the endoscope that don’t show up well on x rays. The physician can also insert instruments into the scope to treat bleeding abnormalities or remove samples of tissue (biopsy) for further tests.

Possible complications of upper endoscopy include bleeding and puncture of the stomach lining. However, such complications are rare. Most people will probably have nothing more than a mild sore throat after the procedure.

Endoscopic retrograde cholangiopancreatography (ERCP) enables the physician to diagnose problems in the liver, gallbladder, bile ducts, and pancreas. The liver is a large organ that, among other things, makes a liquid called bile that helps with digestion. The gallbladder is a small, pear-shaped organ that stores bile until it is needed for digestion. The bile ducts are tubes that carry bile from the liver to the gallbladder and small intestine. These ducts are sometimes called the biliary tree. The pancreas is a large gland that produces chemicals that help with digestion and hormones such as insulin.

ERCP is used primarily to diagnose and treat conditions of the bile ducts, including gallstones, inflammatory strictures (scars), leaks (from trauma and surgery), and cancer. ERCP combines the use of x rays and an endoscope, which is a long, flexible, lighted tube. Through the endoscope, the physician can see the inside of the stomach and duodenum, and inject dyes into the ducts in the biliary tree and pancreas so they can be seen on x rays.

For the procedure, you will lie flat on your stomach on an examining table in an x-ray room. You will be given a sedative to help you relax during the exam. You will swallow the endoscope, and the physician will then guide the scope through your esophagus, stomach, and duodenum until it reaches the spot where the ducts of the biliary tree and pancreas open into the duodenum. At this time, the physician will pass a small plastic tube through the scope. Through the tube, the physician will inject a dye into the ducts to make them show up clearly on x rays. X rays are taken as soon as the dye is injected.

If the exam shows a gallstone or narrowing of the ducts, the physician can insert instruments into the scope to remove or relieve the obstruction. Also, tissue samples (biopsy) can be taken for further testing.

Possible complications of ERCP include pancreatitis (inflammation of the pancreas), infection, bleeding, and perforation of the duodenum. Except for pancreatitis, such problems are uncommon. You may have tenderness or a lump where the sedative was injected, but that should go away in a few days.

ERCP takes 30 minutes to 2 hours. You may have some discomfort when the physician blows air into the duodenum and injects the dye into the ducts. However, the pain medicine and sedative should keep you from feeling too much discomfort. After the procedure, you will need to stay at the hospital for 1 to 2 hours until the sedative wears off. The physician will make sure you do not have signs of complications before you leave. If any kind of treatment is done during ERCP, such as removing a gallstone, you may need to stay in the hospital overnight.

No. With modern anesthetic sedatives you should be comfortable during the examination. However, in very rare circumstances patients may recall the procedure and discomfort.
There are four factors that will contribute to the total time you will spend at our facility for your procedure. They include registration, pre-operative nursing evaluation / check-in, procedure time and recovery. A patient’s average stay is two to two and a half hours.
The findings as well as interventions performed will be written on your discharge paperwork and the physician will speak to your driver unless you request otherwise. A procedure report will be dictated that day and sent to your primary care or referring physicians. If a tissue sample was taken (biopsy or polyp removal), those results are usually available in one week. The physician will give instructions on your discharge paperwork on how to receive those pathology results.
Endoscopic examinations such as colonoscopy and upper endoscopy require sedation. The sedation is to promote comfort to the patient but will make you sleep / groggy for several hours and slow your reflexes for up to a day. This is why you cannot drive your car or perform activities that require concentration or quick reflexes. It is necessary for you to come with a friend or family member who can drive you home safely after your exam is over. We prefer that your driver come with you and stay the entire time that you are under our care. This will make them available for questions and allows the doctor to meet with them in recovery to discuss the results and recommendations.
This is a very light form of anesthesia where the patient does not even lose consciousness. It is used for endoscopy procedures. Sedative drugs are used in very low doses so that the patient is rendered free of any anxiety and discomfort, but can communicate verbally throughout the procedure. In addition, it results in amnesia and as a result patients will not recall their procedure. A more appropriate term is ‘moderate sedation’ whereas ‘deep sedation’ describes the use of a general anesthetic that renders a patient unconscious.
Typically you will receive a combination of two drugs—Versed and Demerol or Fentanyl. Versed results in sedation and amnesia (short term memory loss). Demerol and Fentanyl are narcotics which reduce discomfort and augment the effects of Versed.
Although some patients can tolerate endoscopy well without sedation, most cannot and therefore we recommend sedation.
Yes. There are circumstances when we are unable to achieve adequate sedation safely. Factors that can contribute include patient’s health, current medications or alcohol use. Fortunately this situation occurs rarely. If you would like we can schedule your procedure with an anesthesiologist who will provide deep sedation with a general anesthetic such as Propofol. This may increase your out-of-pocket costs.
You may take critical medications with a small amount (sips) of water on the day of your scheduled procedure. However, please speak with our office staff at least one week before your procedure regarding the use of insulin or blood thinners such as Coumadin (warfarin), Plavix, Ticlid or Persantine.
No. Endoscopy procedures including interventions such as biopsy, polyp removal or dilations can be performed safely in patients who take aspirin daily.
The guidelines from the American Society for Gastrointestinal Endoscopy (www.asge.org) do not require antibiotics to be given prior to endoscopy for any conditions with the exception of feeding tube placement or stricture dilations in patients with artificial heart valves or history of endocarditis. If you have concerns about this please bring it to the attention of the nurse and physician prior to sedation.
For your safety your false teeth will need to be removed once you are sedated. However, you can wear them up to that point immediately before the medications are being administered.
In some circumstances it may be necessary to reschedule in particular if you ate during the morning of your exam or ate solid food during your colon prep the day prior. However, some indiscretions can slide such as taking fiber supplements, iron pills or red or purple clear liquids. Nevertheless, when in doubt please call our office at (317) 872-1161 for guidance..
There is no need to postpone your procedure while you are menstruating. In addition, using a tampon will not interfere with the exam. Inform the nurse and physician when you are going through your pre-procedure interview.
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Physician / Office / Miscellaneous

You may contact our office from 9 a.m. to 11:45 a.m. and 1 p.m. to 4:30 p.m. Monday thru Thursday, as well as 9 a.m. to 12 p.m. on Friday, with the exception of certain holidays. We are also closed for lunch from 12:00 p.m. to 1:00 p.m.

We will make every effort to schedule you for the earliest available appointment which is usually within 1-3 weeks. We also maintain a waiting list so that patients can be rescheduled for earlier appointments as a result of cancellation or unexpected opening.

You can also schedule a visit using our web site by completing the Office Visit Request form.

If you need refills mailed or called in before your next scheduled appointment, please complete the Prescription Refill Request form found on our web site. If you do not have internet access, please call our office during regular business hours. We will make every effort to refill prescriptions on the day they are received but ask that you allow us two business days. Please check with your pharmacy directly to determine if the refill has been called in. If we are unable to refill your request you will be notified by phone or email. Finally, narcotics and other controlled substances will only be refilled during business hours. We ask that you do not call the on call physician for refill requests.

All of our physicians are certified through the American Board of Internal Medicine.

We recommend them all. Like all of us each is unique and different. However, if you prefer a particular day of the week or location this will limit your options as our physicians are scheduled to cover one of three locations each day. Many times patients will defer to the discretion of their primary care physician. Alternatively, speak to your friends who may have been under our care as well.

If the call is local please use our main number (317) 872-1161. If you are out of town our toll free number is (866) 282-5687. Indiana Gastroenterology, Inc. does not have voice mail. Your call is handled in the order it was received. Hold times will vary. We appreciate your patience as we direct your call to the appropriate staff member and your understanding that each call is given personal attention. If your call is of an emergent nature, please inform us immediately or go to the nearest emergency room.

If you have a life threatening emergency go to the nearest emergency room or dial 911. If you have an urgent matter during business hours, call our office (317) 872-1161 and we will forward your concern to your physician.

If you have an urgent medical question or concern when the office is closed call the main number (317) 872-1161 which will forward you to our exchange. The physician on call will return your call as quickly as possible. In rare circumstances it may take up to an hour before the physician returns your call. Routine (non-critical) prescription refills and controlled substance refills will not be handled after hours. In addition, test results should only be requested during business hours as the on call physician will not have access to your complete medical record.

Many of our patients prefer a bilingual family member accompany them. An outside Interpreter will be provided free of charge when requested in advance. You will need to be scheduled thru our office. A 24 hour cancellation is required by these outside services and may be billed to the patient if determined to be a no show/no call.

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