Inflammatory Bowel Syndrome




For Members


Inflammatory bowel disease (IBD) is an umbrella term used to describe group of disorders that involve chronic inflammation of your digestive tract.

IBS is a disorder of the gastrointestinal (GI) tract. IBD is inflammation or destruction of the bowel wall, which can lead to sores and narrowing of the intestines. It’s possible to have both IBD and IBS.


What is Inflammatory Bowel Syndrome (IBS)?

IBS is not classified as a true disease, it is known as a ‘functional disorder’ (e.g. chronic fatigue syndrome – CFS). This means that the symptoms do not have an identifiable cause. It may be treated with certain medications such as intestinal antispasmodics [e.g., hyoscyamine (Levsin) or dicyclomine (Bentyl)].


What is Inflammatory Bowel Disease (IBD)?

IBD is a relapsing and remitting condition characterized by chronic inflammation at various sites in your gastrointestinal tract, which results in bloody diarrhea, abdominal pain and fever. IBD treatment depends on the type diagnosed. The primary goal is treating and preventing inflammation. Over time, this can damage the intestines. Types of IBD include:

  • Ulcerative colitis: This condition causes long-lasting inflammation and sores (ulcers) in the innermost lining of your large intestine (colon) and rectum. Ulcerative colitis is limited to the colon or large intestine.
  • Crohn’s disease: This type of IBD is characterized by inflammation of the lining of digestive tract, which often spreads deep into affected tissues. Crohn’s disease can involve any part of the gastrointestinal tract from the mouth to the anus. Most commonly, it affects the last part of the small intestine or the colon or both.


What are Signs & Symptoms?

  • Diarrhea that may be bloody.
  • Fever and fatigue.
  • Abdominal pain/cramps and cramping.
  • Blood in your stool.
  • Reduced/Loss of appetite.
  • Unintended weight loss.
  • Severe urgency to have a bowel movement.
  • Iron deficiency anemia due to blood loss.





For Healthcare Providers





  • All services require pre-approval from Nextcare.
  • Endoscopic investigation in patients with chronic colitis is quite accurate for the differential diagnosis between ulcerative colitis and Crohn’s disease, submit the report if already performed.
  • Routine Investigations:
    • CBC
    • CRP/ESR
    • Albumin
    • Stool culture
    • Fecal calprotectin
    • Iron studies
    • Celiac Serology
Covered CPT Detail Approval Guidelines
45378 Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) Approved once a year per member per policy.
45379 with removal of foreign body(s)
45380 with biopsy, single or multiple