The priciest outpatient procedure: The colonoscopy

Colonoscopies are one of the most notoriously uncomfortable procedures for U.S. residents aged 50 to 75. It's not easy fasting for 24 hours, processing strong laxatives, undergoing a sedation process, and then finding a ride home.

Unfortunately, the cost of a colonoscopy doesn't make the procedure any more pleasant. According to New Choice Health, out-of-pocket costs for a colonoscopy can range between $1,250 to $4,800, which aligns with the average cost of a colonoscopy (CPT code 45380) we see in the Atlas All-Payor Claims dataset.

More and more patients, however, are booking their colonoscopies at local outpatient facilities (or ambulatory surgery centers), rather than their nearest hospital.

Below, we used SurgeryCenterView and the Atlas All-Payor Claims datasets to explore some of the latest trends in colonoscopy procedures in the claim year 2023.

Top 10 colonoscopy procedures in 2023

Rank	HCPCS/CPT Code	HCPCS/CPT Description	% of Total Procedures
1	45385	COLONOSCOPY W/LESION REMOVAL	38.20%
2	45380	COLONOSCOPY AND BIOPSY	36.80%
3	45378	DIAGNOSTIC COLONOSCOPY	21.10%
4	45381	COLONOSCOPY SUBMUCOUS NJX	1.70%
5	45384	COLONOSCOPY W/LESION REMOVAL	1.00%
6	45390	COLONOSCOPY W/RESECTION	0.40%
7	45388	COLONOSCOPY W/ABLATION	0.30%
8	45382	COLONOSCOPY W/CONTROL BLEED	0.20%
9	45398	COLONOSCOPY W/BAND LIGATION	0.10%
10	44388	COLONOSCOPY THRU STOMA SPX	0.10%

Fig. 1 Data is sourced from Definitive Healthcare's SurgeryCenterView and the Atlas All-Payor Claims products. Data accessed August 2024.

What are the most commonly performed colonoscopy procedures?

The most commonly performed colonoscopy procedure found in our database is CPT code 45385. This code is used when a colonoscopy is performed, and a polyp or other abnormal growth is found and removed during the procedure. The snare technique is a common method used for removing these lesions. This procedure accounts for 38.2% of all colonoscopy procedures performed in 2023, according to the most recent 12-month interval in our database.

Following closely behind in second is CPT code 45380, comprising 36.8% of procedures. This code is used when a colonoscopy is performed and a biopsy is taken of the colon tissue, either one or multiple samples.

In third place is CPT code 45378, comprising 21.1% of colonoscopy procedures. This code is used when a colonoscopy is performed for diagnostic purposes and samples are collected using a brush or washing technique, but no biopsy or other procedures are done.

The top three on our list account for most of the colonoscopy procedures performed in 2023. CPT code 45378 is the base code for a diagnostic colonoscopy, covering the most basic procedure. It's used in a wide range of patients, from screening to those with symptoms. Furthermore, biopsies are often necessary to diagnose conditions like inflammatory bowel disease or to confirm the nature of suspicious lesions. Polyps are common findings during colonoscopies and are especially prevalent as people age. Their removal through polypectomy (CPT code 45385) is an effective measure for preventing colon cancer.

Top 10 ASCs with the most colonoscopy procedures

Rank	Definitive ID	ASC	City	State	% of Total Procedures
1	558783	MidAtlantic Endoscopy 1 (FKA Regional Gastroenterology Associates of Lancaster Surgery)	Lancaster	PA	0.90%
2	1070950	OneGI - Germantown	Germantown	TN	0.70%
3	557307	GI Associates & Endoscopy Center - Flowood (FKA GI Associates Endoscopy - Jackson)	Flowood	MS	0.70%
4	556586	Maryland Center for Digestive Health with Anne Arundel Gastroenterology Associates PA (AKA MCDH)	Annapolis	MD	0.60%
5	555315	Jacksonville Center for Endoscopy - Southside	Jacksonville	FL	0.60%
6	559543	Austin Endoscopy Center - North	Austin	TX	0.50%
7	559397	Gastroenterology Consultants of San Antonio - Medical Center	San Antonio	TX	0.50%
8	554961	Baptist Health Endoscopy Center at Galloway North	Miami	FL	0.40%
9	558129	Endoscopy Center of North Carolina	Asheville	NC	0.40%
10	559515	Kelsey-Seybold Clinic - ASC at Main Campus	Houston	TX	0.40%

Fig. 2 Data is sourced from Definitive Healthcare's SurgeryCenterView and the Atlas All-Payor Claims products. Data accessed August 2024.

Which ASCs had the most colonoscopy claims in 2023?

MidAtlantic Endoscopy 1, located in Lancaster, PA, had the highest percentage of colonoscopy procedures in 2023, at 0.9%.

Tied for second is OneGI - Germantown in Tennessee, and GI Associates & Endoscopy Center in Flowood, MS. Each ASC performed 0.7% of colonoscopy procedures.

And in third place is the Maryland Center for Digestive Health with Anne Arundel Gastroenterology Associates in Annapolis, Maryland, at 0.6%.

Is a colonoscopy considered an outpatient procedure?

Under most circumstances, a colonoscopy can be done as an outpatient procedure, meaning the patient doesn't need to stay overnight in a hospital or facility. The Mayo Clinic states that colonoscopies typically take about 30 to 60 minutes to complete.

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