Two RGAL Nurses and a gastroenterologist

A Screening or Diagnostic Colonoscopy? What is the Difference?

As we approach the end of the year, it is important to schedule a colonoscopy screening. Regional Gi receives many questions regarding the difference between a screening and diagnostic colonoscopy procedure.

It is important to understand the difference between a screening and diagnostic colonoscopy screening. It is very important that you talk to your insurance company on your benefits and their criteria, as this can have an effect on your out-of-pocket costs such as deductibles or coinsurance. Most insurance plan will cover screening colonoscopies, while diagnostic will be applied to your deductible or coinsurance.

Screening Colonoscopy Factors

  • No symptoms before the procedure
  • No finding during the procedure (polyps, diverticulosis, etc.)
  • No personal family history or polyps
  • No family history of cancer or polyps (some insurances consider this high risk)

Diagnostic Colonoscopy Factors

  • Symptoms before the procedure such as change in bowel habits, rectal bleeding, abdominal pain, etc.
  • Findings during the procedure (polyps, cancer, diverticulosis, etc.)
  • Personal history of cancer or polyps
  • Family history of cancer or polyps (some insurances consider this high risk)

Important Note: Regional Gi follows appropriate coding guidelines and procedures. A screening procedure many become diagnostic based on findings during colonoscopy or symptoms you are experiencing.

The points noted above are to be used for informal purposes only, as insurance and benefits criteria vary by plan.

If you have any questions or concerns, please contact your insurance company to verify your benefits and out-of-pocket costs for your screening or diagnostic colonoscopy.

Feel free to share the attached PDF.