683 a) Initial Colonoscopy: A sustained alteration in bowel habit – either constipation, diarrhoea or alternating constipation and diarrhoea 684 b) Initial Colonoscopy: Rectal bleeding 685 c) Initial Colonoscopy: Unexplained anaemia 686 d) Initial Colonoscopy: Persistent unexplained lower abdominal pain 687 e) Initial Colonoscopy: Abdominal mass 688 f) Initial Colonoscopy: Obstructive symptoms 689 g) Initial Colonoscopy: Abnormal gastrointestinal imaging 690 h) Initial Colonoscopy: Assessment of geography and severity of colitis 691 i) Initial Colonoscopy: Tattooing margins of colonic polyp or colonic neoplasm prior to laparoscopic resection 823 j) Initial Colonoscopy: Investigation of unexplained weight loss 623 ja) Initial Colonoscopy: Rectal mass 624 jb) Initial Colonoscopy: Unexplained anal mass or unexplained anal ulceration 14 k) Repeat Colonoscopy: Following incomplete polypectomy, where multiple or large adenomas could not be satisfactorily cleared in one endoscopy session 15 l) Repeat Colonoscopy: Pre-operative assessment of chronic inflammatory bowel disease (IBD) 16 m) Repeat Colonoscopy: Relapse or flare up of IBD or following change of therapy to assess response 824 n) Repeat Colonoscopy: Ileo-colonoscopy 6-12 months post resection of Crohn’s disease to assess surgical anastomosis 17 o) Repeat Colonoscopy: Post-colonic cancer surgery at years 1 and 3 and then every 5 years thereafter 19 p) Repeat Colonoscopy: Where the patient’s presenting symptoms indicate that a left-sided colonoscopy or sigmoidoscopy/proctoscopy is necessary and where the findings from that procedure suggest the possibility of disease elsewhere in the colon necessitating complete colon examination. The findings are as follow: - Colonic polyps, - Colonic carcinoma, - Inflammatory bowel disease, - Blood-stained mucus or stool coming from beyond the range of a sigmoidoscopy/proctoscopy examination 20 q) Repeat Colonoscopy: Repeat full colonoscopy when there is unexplained deterioration in symptomatology not explained by left-sided colonoscopy 21 r) Repeat Colonoscopy: Left-sided colonoscopy to assess disease activity at the time of significant reduction or withdrawal of medication 22 s) Repeat Colonoscopy: Left-sided colonoscopy at the time of significant symptomatic relapse 23 t) Repeat Colonoscopy: Left-sided colonoscopy where there is a failure to respond to treatment or where there is suspicion of a second diagnosis such as Clostridium difficile infection with superimposed pseudomembranous colitis 316 u) Repeat Colonoscopy: Evaluation of an abdominal mass 783 v) Repeat Colonoscopy: Other exceptional reasons provided a comprehensive medical report accompanies the claim outlining the medical necessity for the procedure e.g. repeat endoscopy recommended on pathology report 146 w) Surveillance Colonoscopy: Individuals with one first-degree relative diagnosed with colorectal cancer before age of 60 years. Benefit will be provided for colonoscopy before age of 40 years, or 10 years before the age at diagnosis of the youngest affected relative, whichever is the first, and, if normal, repeats at five-yearly intervals 148 x) Surveillance Colonoscopy: Individuals with a genetic or clinical diagnosis of hereditary non-polyposis colorectal cancer (HNPCC) (Lynch Syndrome): Benefit will be provided for colonoscopy every 12 months beginning at age 20 years, or 10 years before the age at diagnosis of the youngest affected relative in the immediate family 149 y) Surveillance Colonoscopy: Individuals with one first-degree relative diagnosed with colorectal cancer or an advanced adenoma after the age of 60 years: Benefit will be provided for colonoscopy from age 40 years, or 10 years before the age at diagnosis of the affected relative, whichever is the first, and, if normal, repeats at five-yearly intervals 825 z) Surveillance Colonoscopy: Individuals with one second-degree relative diagnosed with colorectal cancer before the age of 50: Benefit will be provided for a single colonoscopy at or after age 50 years. No benefit will be paid for repeat colonoscopy unless other indications have been met 826 za) Surveillance Colonoscopy: Individuals with one first-degree relative with an advanced adenoma before age 60 years or two first degree relatives diagnosed with an advance adenoma at any age. Benefit will be provided for colonoscopy from age 40 years, or 10 years before the age at diagnosis of the youngest affected relative, whichever is the first, and, if normal, repeats at five-yearly interval 720 zb) Surveillance Colonoscopy: Family history of familial adenomatous polyposis (FAP): Mutation carriers: Benefit will be provided to mutation carriers for yearly colonoscopy alternating with sigmoidoscopy from age 10, unless an adenoma(s) develops in which case benefit will be provided for annual full colonoscopy until polyp load indicates the need for surgery 731 zc) Surveillance Colonoscopy: Family history of familial adenomatous polyposis (FAP): Where no mutation can be identified, for family members at 50% risk, age 13 – 30 years: Benefit will be provided for colonoscopy alternating with sigmoidoscopy every year up to age 30 years 733 zd) Surveillance Colonoscopy: Family history of familial adenomatous polyposis (FAP): where no mutation can be identified, for family members at 50% risk, age 30 – 60 years: Benefit will be provided for colonoscopy alternating with sigmoidoscopy every 3 years until age 60 years 827 ze) Surveillance Colonoscopy: Peutz-Jeghers Syndrome: Colonoscopy every 2 years starting at age 25 years 828 zf) Surveillance Colonoscopy: Juvenile polyposis: Colonoscopy every 2 years starting at age 15 years 829 zg) Surveillance Colonoscopy: MUTYH-associated polyposis (MAP): Colonoscopy every 2 years starting at age 25 years 781 zh) Surveillance Colonoscopy: Adenomas - Low risk adenomas (tubular, 1-2, less than 1cm with low-grade dysplasia) identified on previous colonoscopy: Benefit will be provided for a repeat colonoscopy at 5 years (further endoscopy benefits may be paid if relevant pathology found at repeat colonoscopy) 830 zi) Surveillance Colonoscopy: Intermediate risk adenomas (3 - 4 small adenomas, or at least one adenoma 10-19mm identified on previous colonoscopy or any adenoma with villous features ir high grade dysplasia. Benefit will be provided for 3-yearly colonoscopies until 2 consecutive negative colonoscopies, then no further colonoscopies 831 zj) Surveillance Colonoscopy: High risk adenomas (greater than or equal to 5 small or any adenoma greater than or equal to 20mm). Annual colonoscopy until out of this risk group then interval colonoscopy as per intermediate risk group i.e. benefit will be provided for 3-yearly colonoscopy until 2 negative colonoscopies. 832 zk) Surveillance Colonoscopy: Colonoscopic surveillance for colorectal cancer from 8 years after onset of IBD: Low risk - Benefit will be provided for colonoscopy every 5 years 833 zl) Surveillance Colonoscopy: Colonoscopic surveillance for colorectal cancer from 8 years after onset of IBD: Intermediate risk, i.e. extensive colitis with mild active disease or post-inflammatory polyps or history of colorectal cancer in a first degree relative aged 50 years or older - Benefit will be provided for colonoscopy every 3 years 834 zm) Surveillance Colonoscopy: Colonoscopic surveillance for colorectal cancer from 8 years after onset of IBD: High Risk, i.e. extensive colitis with moderate/severe active disease or stricture in past 5 years, or dysplasia in past 5 years, or concurrent primary sclerosing cholangitis, or colorectal cancer in a first degree relative under 50 years old - Benefit will be provided for colonoscopy every year 835 zn) Surveillance Colonoscopy: Patients with Acromegaly: Benefit will be provided for colonoscopy every 3 years starting at age 40 836 zo) Surveillance Colonoscopy: Sigmoidoscopy Surveillance: Patients post ureterosigmoidostomy: Benefit will be provided for annual flexible sigmoidoscopy starting 10 years after surgery 625 zp) Surveillance Colonoscopy: After colon surgery for FAP every 6 months if some rectal tissue remains and every year if all rectal tissue has been removed and there is a small intestinal pouch