How To Use HCPCS Code G9659

HCPCS code G9659 describes the specific circumstances under which a patient who is 86 years of age or older undergoes a screening colonoscopy without a history of colorectal cancer or any other valid medical reason for the procedure. This code is used to accurately identify and bill for this particular scenario, ensuring proper reimbursement for healthcare providers.

1. What is HCPCS G9659?

HCPCS code G9659 is a specific code used in medical coding to identify patients who are 86 years of age or older and have undergone a screening colonoscopy without a history of colorectal cancer or any other valid medical reason for the procedure. This code is essential for accurately documenting and billing for this specific scenario.

2. Official Description

The official description of HCPCS code G9659 is as follows: “Patients greater than or equal to 86 years of age who underwent a screening colonoscopy and did not have a history of colorectal cancer or other valid medical reason for the colonoscopy, including: iron deficiency anemia, lower gastrointestinal bleeding, Crohn’s disease (i.e., regional enteritis), familial adenomatous polyposis, Lynch syndrome (i.e., hereditary non-polyposis colorectal cancer), inflammatory bowel disease, ulcerative colitis, abnormal finding of gastrointestinal tract, or changes in bowel habits.” The short description for this code is “>=86y no hx colo ca/rsn scop.”

3. Procedure

  1. The procedure for HCPCS code G9659 involves performing a screening colonoscopy on a patient who is 86 years of age or older.
  2. The patient should not have a history of colorectal cancer or any other valid medical reason for the colonoscopy, such as iron deficiency anemia, lower gastrointestinal bleeding, Crohn’s disease, familial adenomatous polyposis, Lynch syndrome, inflammatory bowel disease, ulcerative colitis, abnormal finding of gastrointestinal tract, or changes in bowel habits.
  3. The screening colonoscopy is a diagnostic procedure that allows healthcare providers to examine the colon and rectum for any abnormalities or signs of colorectal cancer.
  4. During the procedure, a flexible tube with a light and camera, called a colonoscope, is inserted into the rectum and guided through the colon.
  5. The healthcare provider carefully examines the lining of the colon and may remove any polyps or abnormal tissue for further analysis.
  6. Once the procedure is complete, the patient is monitored for any potential complications and provided with appropriate post-procedure care.

4. When to use HCPCS code G9659

HCPCS code G9659 should be used when documenting and billing for a screening colonoscopy performed on a patient who is 86 years of age or older and does not have a history of colorectal cancer or any other valid medical reason for the procedure. It is important to ensure that the patient meets the specific criteria outlined in the official description of the code.

5. Billing Guidelines and Documentation Requirements

When using HCPCS code G9659, healthcare providers need to document the patient’s age, the absence of a history of colorectal cancer, and the lack of any other valid medical reason for the screening colonoscopy. This documentation is crucial for accurate billing and reimbursement. Providers should also ensure that the medical record includes any relevant clinical findings or observations related to the procedure.

6. Historical Information and Code Maintenance

HCPCS code G9659 was added to the Healthcare Common Procedure Coding System on January 1, 2016. As of January 1, 2021, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. It is important for medical coders and healthcare providers to stay updated on any changes or revisions to the code in order to ensure accurate documentation and billing.

7. Medicare and Insurance Coverage

Medicare and other insurance providers may cover the screening colonoscopy performed under HCPCS code G9659, but coverage may vary depending on the specific policies and guidelines of each insurance plan. It is important to review the pricing indicator code and multiple pricing indicator code associated with this code to understand how the service or supply is priced by Medicare or other insurers.

8. Examples

Here are five examples of scenarios in which HCPCS code G9659 should be billed:

  1. An 88-year-old patient without a history of colorectal cancer undergoes a screening colonoscopy as part of routine preventive care.
  2. A 90-year-old patient with no valid medical reason for a colonoscopy undergoes a screening procedure as recommended by their healthcare provider.
  3. An 86-year-old patient with no history of colorectal cancer or any other valid medical reason for the procedure undergoes a screening colonoscopy due to their age.
  4. A 92-year-old patient without any indications of colorectal cancer or other valid medical reasons undergoes a screening colonoscopy as part of their regular healthcare maintenance.
  5. An 87-year-old patient who meets all the criteria for a screening colonoscopy undergoes the procedure without any history of colorectal cancer or other valid medical reasons.

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