Colonoscopy codes in CPT® 2009 all include moderate sedation, but a recent trend in the United States may be an indicator of things to come. Will the drive to lower health care spending be the impetus providers need to perform colonoscopies on patients without sedation?

It isn’t unusual for doctors in other parts of the world to perform diagnostic colonoscopies on consenting nonsedated patients, but until recently it’s practically unheard of in the states. An AMNews Jan. 12 story tells how the practice of performing colonoscopies without sedation has allowed one Californian doctor to continue offering the service during a nursing shortage, and why other medical experts fear change.

39 Responses to “Study Supports Colonoscopy without Sedation”

1. E Smith Says:
   February 4th, 2009 at 3:30 pm

   I am afraid if patients will be asked to get the colonoscopy without sedation we will have less patient getting the procedure done and colon cancer will be on the rise. My husabnd is a colon cancer patient and I know without the sedation he will not get another colonoscopy.

2. JWilson Says:
   February 4th, 2009 at 4:01 pm

   I haven’t undergone a colonoscopy due to my age and not being high-risk as I have no family history of rectal or related cancers. Having said that, I would postpone the procedure indefinitely if I had to have it performed without some sort of sedation.

3. ADreistadt Says:
   February 4th, 2009 at 4:19 pm

   I have a colonoscopy every five years because my father died of colon cancer which spread to his liver. I will not have a colonoscopy without sedation. I agree with E. Smith and J. Wilson and their comments. I would even be willing to pay for the Versed and administration of same, but I definitely would not be willing to go through this test without some Versed.

4. Penny Nelson Says:
   February 4th, 2009 at 4:42 pm

   I had my first Colonoscopy in 2003. I have hypersensitivities so the provider infused as little Versed as possible. I felt it at the splenetic flexure and he had to infuse more. I cannot imagine a colonoscopy without versed. Some Military hospitals have done it without sedation and it is very painful.

5. AB Says:
   February 4th, 2009 at 5:24 pm

   I had colonoscopy few years back and the md did not provide enough sedation. I will never go through another colonoscopy unless I am totally sedated. It is painful without the sedation.

6. DMRamos Says:
   February 4th, 2009 at 8:44 pm

   I remember the first time I was not given enough sedation I grabbed on to the nurse with my nails digging into her arm. It is one of the most painful procedures for anyone to have to experience. I too have a Colonscopy every 2 years due to a high risk of Colon CA which runs in both sides of my family.

7. Susan Says:
   February 4th, 2009 at 8:47 pm

   I had a sigmoioscopy without any sedation back in 1982 and had to breathe like I was giving birth just to get through the procedure–not to mention the humiliation of practically being stood on my head while it was being done. In 2007, I had a colonoscopy and was fully sedated during the outpatient procedure. After having experienced both procedures, there is absolutely no way I’d ever have either one of those procedures done in the future without sedation. If this becomes a payor issue in the future, I hope AMA lobbyists will step in and get it stopped.

8. Mary Says:
   February 5th, 2009 at 5:33 am

   I had my colonoscopy just last week. I also, was not given enough sedation and woke up.. It was so painful I’m thinking I never will go back. However, my mother died from colon cancer and I did have a polyp that was removed, so I know how important it is to have this test. My first procedure 5 years ago was a breeze – I did not wake up until I was in recovery – this was with a different physician. It must be up to the indvidual physician on how much versed to administer. I will go back, but to the physician who performed my first test

9. Karen Says:
   February 5th, 2009 at 6:03 am

   Another arguement for the new CT Scan/MRI technology.
   Due to the prep being the same, if polyps or other issues are spotted, there would be no reason for not wheeling you from the imaging source directly into a surgical suite to attend to the problem. I will gladly pay for the sedation out-of-pocket. That’s the only way they’d ever see me. The test is humiliating enough and the prep is barbaric to say the least. The last familiy member that had this done had to have the procedure cancelled. Due to the prep and a judgemental, uncaring nurse at the office, said fmly member was so dehydrated the day of the procedure, they couldn’t access a vein for the I.V. Because it was routine, she’s never gone back.

10. SB Says:
    February 5th, 2009 at 6:25 am

    I would absolutely NOT have a colonoscopy without sedation. Colonoscopy suites are supplied with tools to handle polyps, cautery, etc., so there isn’t need to go anywhere else if a minor problem is diagnosed. If you are under sedation already, physicians prefer the calm atmosphere if they had to perform any procedure. My first colonoscopy diagnosed AVMs in the colon and I was anxious going into it just due to the “what if’s” and “pros and cons” list. I would not have had it without sedation. The second colonoscopy diagnosed actual bleeds which were cauterized and taken care of at the time of colonoscopy. I could not imagine not being sedated for that, as I was “sore” for several days afterwards. Patients should not have to pay for medication when accompanying any invasive procedure.

11. LB Says:
    February 5th, 2009 at 7:07 am

    I finally talked my father into getting a colonoscopy due to family history of colon cancer. He was not given sedation, this was many years ago. He said it was the most painful experience he has ever had and will not have another one, even with sedation.

12. Danette Says:
    February 5th, 2009 at 7:41 am

    My sister had a colonoscopy in December and woke up in the middle of it. It was so painful she was screaming, and she has a high pain tolerance. They gave her more medication but it was almost too late to help. If the patient has a twisted colon it it difficult to manoeuvre the scope which in turn causes undo pain to the patient. They most definately need to be comfortable in that situation.
    I had one a couple of years ago and had Versed and it was a piece of cake.

13. Beverly Says:
    February 5th, 2009 at 7:46 am

    I have had this procedure 3 times. The first was done while I was 16 weeks pregnant. They used minimal sedation, I felt it, and I had a death grip on the nurse, she likely went home with bruises on her arm that day. I will not have this done again unless adequate sedation is given. If I have to pay for it out of pocket, or bring my own, whatever it takes, this girl goes under, or she won’t go at all!!

14. Ann Says:
    February 5th, 2009 at 7:49 am

    Evidently the person(s) proposing this idea has never had a colonoscopy. Maybe we should schedule them for a screening colonoscopy without sedation and see if they still have the same proposal after the procedure.

15. PK Says:
    February 5th, 2009 at 7:52 am

    I have a family history of Colon Cancer so I had my screening early. Since I am a coder and have coded many colonoscopies, I wanted to see for myself the inside of a colon hoping to understand the procedure as I coded them, I asked the nurse if I could watch. My definition of “watching” was “could you turn the screen towards me so I can see”. However, the nurse’s definition of “watching” was NO MEDS!!!!!!! By the time I was screaming for meds, I was told “I’m almost done, so there is no need for it” I, too, like Susan was doing Lamaze breathing just to get through it. Next time I definately WILL be medicated.

16. Jeanne Says:
    February 5th, 2009 at 7:58 am

    I have had 4 colonscopy screenings and have risk as my father died of colon cancer. I can’t even imagine how it would be without sedation as it was uncomfortable with it. I would say I would pass on future screenings also if it is without sedation, and just take my chances.

17. Holly Says:
    February 5th, 2009 at 9:14 am

    This is where healthcare has taken us…to save money we have to torture patients. There are so many ways to save money it should not be at our patients expense. What a sad day that would be. Just step back to the frontier days when they gave you a shot of whiskey and a bullet to bite on.

18. PB Says:
    February 5th, 2009 at 10:07 am

    I say let all the payer decision-makers have the procedure without sedation – I don’t think they would be so quick to make sedation a non-covered procedure with colonoscopies!

19. J Todd Says:
    February 5th, 2009 at 11:32 am

    I had my first colonoscopy in November 2008. My physician was wonderful, as was his nurse, but even though I did not really “feel” sedated, I certainly was. I will have another in 10 years, as required, but not without sedation!

20. S Brewer Says:
    February 5th, 2009 at 12:15 pm

    I have had a colonscopy without sedation and it will NEVER happen again unless I do have sedation. The rate of colon cancer will go up if sedation is not provided to patients and that makes the extra cost for the sedation well worth it.

21. C Rudkin Says:
    February 5th, 2009 at 12:53 pm

    We have several Drs that do colonoscopies in our facility. Until recently all of them were using Versed (conscious sedation). Now some of them are using Propofol, which requires the anesthesiologist to administer. Hopefully the drive to lower cost would mean the Dr can administer the Versed and it would cost out of pocket for the anesthesiologist to give Propofol.

22. Jodie C Says:
    February 6th, 2009 at 8:05 am

    I am only 25 & I had to have my first colonoscopy two weeks ago (due to some symptoms I was exhibiting & a family history.) I was very aprehensive about having this done to say the least. All I kept hearing before hand was how the procedure was nothing because I would be sedated, which was very comforting to me. I had Versed & Propofol both so I was out. If this was not the case & I honestly don’t believe that I would have gone through with the procedure. I would pay out of pocket if needed to ensure I would be sedated but there are many people who aren’t financially able to make that choice.

23. Lavanya Mohan Says:
    February 8th, 2009 at 1:06 am

    For patients with neuro complaints, in pregnant women after 6th month, unable to eat properly, may be anxiety(spastic colon), stress related types of problems even, for patients suffering from hematochezia, and for some patients during post-op period(colon stuck type)- it is not very free to move the colonoscope and hence may need concious sedation before they begin a colonoscopy.

24. D.Garner Says:
    February 8th, 2009 at 4:42 am

    Maybe the powers that be should listen to the voices of experience. I have had 2 colonscopies and would not have had either one without sedation. Neither one took a great amount of time and while the physician assured me that I would be comfortable during the procedure, I actually don’t remember a thing and am glad of it. The sedation allowed me to be at ease and the physician to accomplish what he needed to.

25. Jen B. Says:
    February 8th, 2009 at 8:10 am

    I have Crohn’s, so you can imagine all the testing I have been thru…I did have a flex sigmoid in the office with no sedation…..that was my first experience. I avoided the colonoscopy for a long time and finally consented, with sedation of course, no problem. Unfortunately the powers that be are the ones who also introduced the “outpatient” mastectomies, imagine! and the ones who determined birth control pill should not be covered but Viagra should! go figure……what is part of the oath, physcian do not harm?

26. D.Brummet Says:
    February 9th, 2009 at 6:40 am

    I work for 4 gastroenterologist. They all use sedation. They have had colonoscopies themselves and tried it without sedation. Before the scope was past the rectal vault they were asking for sedation. They know first hand, IT HURTS without sedation. If a patient can’t tolerate regular sedation, our doctors opt for MAC sedation. They will not put their patients thru unecessary pain.

27. Shannon K. Says:
    February 9th, 2009 at 1:54 pm

    I also work for a gastroenterologist and agree with all of the above statements. We’ve also had many patients request actual anesthesia because they have waken up during prior colonoscopies using just versed, so they want to be completely under. It is just ridiculous for anyone to think colonoscopies should be done without sedation. Where’s the humanity, people?!

28. Melissa B Says:
    February 10th, 2009 at 6:03 pm

    Sounding like this is a pain in the rear that should be prevented. Once those physicians start having perforations from patients moving they won’t tolerate this change and may pay out of their own pocket. I can’t imagine this will change, but it may not be considered a third world substandard option.

29. Daughter of a Mother who died of Colon Cancer Says:
    February 15th, 2009 at 5:51 pm

    My mother who passed away from colon cancer w/mets to the lung and spine had a family history of
    with a sister who also had a primary site of colon cancer.

    She experienced her first colonoscopy without enough sedation and told stories of being totally humiliated by the physician, which is why she never had another one until it was too late. She experienced some telling symptoms of the disease but did not follow up on until it was Stage III out of fear, which in todays world of health care is beyond my belief. After the diagnosis she lived 5 years but died a death I would not wish on anyone.

    I, as well as my sister, continue to receive our colonoscopies as scheduled but truly do not believe I will do so without sedation. I agree let the physicians experience first hand this procedure without sedation and see what they say……………………………

30. Joyce Says:
    February 21st, 2009 at 2:57 pm

    I have to say that I have had several colonoscopies and have always had sedation. I had one sigmoidoscopy without sedation and it was very painful. After that I told the MD that I did not want to know anything until that went on until I was awake and he could then explain any problems. He never had a problem with that.

    Maybe that doctor in California needs someone to perform a colonscopy on him without any sedation and see how he feels. The nursing shortage is not so bad that the hospital cannot allow him two nurses in the room with him while he does colonoscopies. He can give the Versed himself for that matter and would only need one nurse. For that matter, my doctor takes his own staff with him when he does colonoscopies. He does not expect the hospital to provide him with nurses.

31. Stephen Says:
    March 2nd, 2009 at 4:55 pm

    I have had a number of colonoscopys since I was diagnosed with stage 3 colorectal cancer. I have had the procedure with and without sedation. I didnt find the procedure as bad as some people are describing.

32. MCKean Says:
    May 12th, 2009 at 3:21 pm

    Pain medication can and should be given. Versed, however, is not a pain killer, but a memory blocking drug. It is used not only to block your memory of the pain, rather than your not suffering the pain to begin with, but is used so they can do things to you that you did not consent to their doing. Such, as a team of students performing rectal exams, or a intern taking the place of the physician you thought would be performing the procedure. Versed is used in the hospital for the same reason it is used in the streets, drug facilitated non-consentual penitration of intimate body parts, i.e. rape, in this case “medical rape”.

33. Lauren Says:
    May 14th, 2009 at 5:46 am

    Colonoscopy can and is done without sedation; the so-called “sedation” is usually with Versed, a patient-control drug that is supposied to make the patient amnesic of the procedure. Sometimes it works, sometimes it doesn’t. Without sedation doesn’t mean without pain control; patients with high does of Versed often scream their heads off, but generally don;t remember this immediately afterwards-until they get home…then things often change. The patient who was dazed and compliant after the exam becomes hostile, angry and depressed. It goes on for months. I have had 3 colonoscopies without sedation, one ith painkiller (fentanyl) only upon demand and all were fine. You have to find a good doc to do it without sedation. The dirty little secret is that most GI docs would never get Versed; they get painkiller only or a real anesthetic: propofol. When someone tells you that they are giving you Versed to make you comfortable; it’s a lie. It’s to make their job easier, turn you into a zombie and possible make you a mental wreck.

34. Linda Says:
    July 30th, 2009 at 8:34 am

    Twelve years ago I had my first and only Colonoscopy. I swore I’d never have another one. I’ve never experience such pain, worse than childbirth. As this procedure was taking place I was gripping the side of the bed rail and screaming, “Jesus, Save Me!” The Dr. asked the nurse, “Is she still awake?” Obviously, he was deaf as I was screaming. She answers, “Yes, should I give her more medication?” (I did have an IV in my left arm) He said, “No, she’s had enough, we’ll be done in a few minutes.”
    I’ve suffered with many colon problems through the years, Diverticulitis, hemmroids, rectal bleeding, constipation, you name it, I’ve probably experienced it many times. Of course, I no longer go to that Dr. I have another Dr. who will give me antibodics when my white cell count is up.
    However, this year I have suffered more from colons problems and have decided to have another Colonoscopy. This time (as last time) I have been promised IV Sedation and absoutely no pain.
    This time it is also taking place in the hospital and not in the Dr.’s office.
    I can promise this, if I feel ANYTHING, I am coming off the table.
    I so wish the Dr. who tortured me twelve years ago would have to go through what he did to me.

35. Gareth Says:
    August 14th, 2009 at 7:36 pm

    Colonoscopy is safer and quite comfortable without sedation. A patient will never get perforated if they are not sedated; this is a fact. Most of the risk of the procedure comes from sedation. Many docs seem to use sedation the the procedural amnesia as an excuse to do the colonoscopy as quickly as possible and quite roughly. Sedation is no bargain is your gastro is motivated by speed; watch a colonoscopy done by a careless gastro on a sedated patient; the poor patient moans and writhes in pain. The gastro relies on the amnesia effect of the drus (usually Versed) to get the temporarily stupefied patient out the door. Then their memory returns and the fun starts. I work in a hospital and was scared to death of this exam and colon cancer runs in my family. I had Versed for dental work once and had long-term memory damage from it; I would never consent to this drug. Check out askapatient.com for the twisted Versed story; it’s not pretty. I finally found a great gastro doc, a young woman who has seen too many patients damaged by Versed; she did my colonoscopy without drugs. She took her time (unlike most gastros) and there was no pain. Oh sure, a little gas-like pain from the air injected, but after she and her nurse encouraged me to fart, that was gone. Why anyone would consent to sedation is beyond me. I had biopsies and 3 polyps removed, got dressed and drove home.

36. Stacy Says:
    February 26th, 2010 at 9:43 am

    I had a colonoscopy without sedation 3 years ago, by choice. I did not want to have problems I saw happen to other people with botched up sedation. Since I was a childbirth educator, and had two natural childbirths without medication, I knew how to get through pain. Some people cannot bear any pain. I would call the colonoscopy procedure uncomfortable. I would not call it painful. People can increase pain perception through “fighting against” the sensations. If you come to terms with it as a necessary and safe procedure, that should ease the mind. I just focused on my steady breathing, watched the monitor and WALKED out of the room and drove myself home.

37. Gary Says:
    March 5th, 2010 at 7:41 am

    The sedation is for the doc’s benefit, not yours. Get it if you want it, I’m a pharmacist and have seen the downside of sedation; way too many people having memory loss and other issues from poorly done sedation. I avoided colonoscopy until one of the nurses whom I work with noticed that I was spending too much time in the bathroom at work (intrusive little nurse probably saved my life)….anyway I specified no sedation for my exam and the gastro doc was glad to do it that way. she talked me thru it and the hardest part was to relax and basically fart on her gloved hand as she advanced the scope. sorry for the image, but it’s true and was pretty funny at the time. leave your modesty at the door and don’t die of embarassment. get it done

38. Lyn Says:
    May 26th, 2010 at 9:11 pm

    I had a colonoscopy without any sedation this week. I would definitely do it again. On admission the head nurse was shocked that I was having no sedation. She said, “you are what, it will be excrutiating”. Sure there was some pain but it was manageable and was only when the scope was going around corners, certainly not excrutiating. I have a fear of anaesthetics so was relieved that the doctor agreed to do it without. I was able to eat breakfast straight after and go home. The doctor removed a small polyp which was painless and I was able to watch the procedure on the screen. The nurses were amazing and encouraged me to deep breath during the painful moments.

39. Never Again Says:
    June 8th, 2010 at 5:01 pm

    Why are you people talking about “sedation” like it’s pain killer? If you are going to be in pain, why would you want amnesia, partial or otherwise instead of pain meds? I just don’t get it. Especially when these people are TELLING YOU it’s going to be “excruciating.” Just wait until you talk to somebody (one of the 10%) who don’t get amnesia from the sedation, and find out about the inhumane torture they were exposed to under the premise that “you won’t remember us treating you like a POW in a 3rd world country.”

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