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Editorials |

The Problem of the Inappropriate Endoscopy

John F. Morrissey, MD
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University of Wisconsin Medical School
Madison, Wisconsin

Ann Intern Med. 1988;109(8):605-606. doi:10.7326/0003-4819-109-8-605
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The rapid escalation of the cost of medical care in the face of limited resources has led insurance carriers, including Medicare, to look hard at high-cost medical procedures such as gastrointestinal endoscopy. Medicare intermediaries have been encouraged to deny payment to physicians for nonindicated procedures. The data available from the medical literature are of limited help in evaluating the appropriateness of procedures. Controlled trials have not been done for most indications. The guidelines of the American Society for Gastrointestinal Endoscopy (1) are excellent, but in each guideline, there is a caution that under exceptional circumstances, procedures may be considered appropriate,


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