Colonoscopy guidelines - Healthnet

Current Policy Statement of Health Net

Health Net, Inc. considers colonoscopy medically necessary according to the revised guidelines set forth by the American Gastroenterological Association, the American Society of Colon & Rectal Surgeons, the American Cancer Society, the U.S. Multi-Society Task Force on Colorectal Cancer, the American College of Radiology, the National Comprehensive Cancer Network, the American College of Gastroenterology, and the American Society for Gastrointestinal Endoscopy for patients who meet any of the following indications:
 

Diagnostic Colonoscopy

1. Evaluation of an abnormality on barium enema or other imaging study, which is likely to be clinically significant, such as a filling defect or stricture.
2. Evaluation of unexplained gastrointestinal bleeding, such as:
     • Hematochezia not thought to be from rectum or perianal source, especially if the patient is > 40 years old.
    • Melena of unknown origin after an upper GI source has been excluded.
    • Presence of fecal occult blood.
3. Unexplained iron deficiency anemia.
4. Chronic inflammatory bowel disease of the colon if more precise diagnosis or determination of the extent of activity of disease will influence immediate management.
5. Clinically significant diarrhea of unexplained origin with additional symptoms (e.g., dehydration, weight loss).
6. Evaluation of acute colonic ischemia/ischemic bowel disease.
7. Evaluation of cytomegaloviral colitis in a patient with HIV infection
8. Evaluation of patient with Streptococcus bovis endocarditis.
9. Intraoperative identification of the site of a lesion that cannot be detected by palpation or gross inspection at surgery (e.g., polypectomy site or location of a bleeding source).
10. Marking a neoplasm for surgical localization.