How To Use HCPCS Code G9660

HCPCS code G9660 describes the documentation of medical reasons for a colonoscopy performed on a patient who is 86 years of age or older. This code is used to indicate the specific medical conditions or symptoms that justify the need for a colonoscopy in this age group. It is important for medical coders to understand the meaning and usage of this code to ensure accurate billing and reimbursement.

1. What is HCPCS G9660?

HCPCS code G9660 is a specific code used to document the medical reasons for a colonoscopy performed on a patient who is 86 years of age or older. It provides information about the underlying conditions or symptoms that necessitate the procedure. This code is essential for accurately capturing the medical necessity of the colonoscopy and ensuring appropriate reimbursement.

2. Official Description

The official description of HCPCS code G9660 is “Documentation of medical reason(s) for a colonoscopy performed on a patient greater than or equal to 86 years of age (e.g., iron deficiency anemia, lower gastrointestinal bleeding, Crohn’s disease, familial history of adenomatous polyposis, Lynch syndrome, inflammatory bowel disease, ulcerative colitis, abnormal finding of gastrointestinal tract, or changes in bowel habits).” The short description for this code is “Doc med rsn scope pt >= 86y.”

3. Procedure

1. The healthcare provider begins by reviewing the patient’s medical history and conducting a physical examination.
2. If the patient is 86 years of age or older and presents with symptoms or conditions that warrant a colonoscopy, the provider proceeds with the procedure.
3. The patient is typically sedated or given anesthesia to ensure comfort during the colonoscopy.
4. A flexible tube with a camera attached, known as a colonoscope, is inserted into the rectum and guided through the colon.
5. The provider carefully examines the lining of the colon, looking for any abnormalities or signs of disease.
6. If necessary, the provider may take tissue samples (biopsies) or remove polyps during the colonoscopy.
7. Once the examination is complete, the colonoscope is slowly withdrawn, and the procedure is concluded.

4. When to use HCPCS code G9660

HCPCS code G9660 should be used when documenting the medical reasons for a colonoscopy performed on a patient who is 86 years of age or older. The code is applicable in cases where the patient presents with specific symptoms or conditions such as iron deficiency anemia, lower gastrointestinal bleeding, Crohn’s disease, familial history of adenomatous polyposis, Lynch syndrome, inflammatory bowel disease, ulcerative colitis, abnormal findings of the gastrointestinal tract, or changes in bowel habits. It is important to accurately capture the medical necessity of the procedure to ensure proper reimbursement.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9660, healthcare providers must ensure that the medical reasons for the colonoscopy are clearly documented in the patient’s medical record. The documentation should include details about the specific symptoms or conditions that justify the procedure, such as laboratory results, imaging findings, or clinical observations. Accurate and thorough documentation is crucial for proper coding and billing.

6. Historical Information and Code Maintenance

HCPCS code G9660 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 to stay updated on any changes or revisions to the code to ensure accurate coding and billing practices.

7. Medicare and Insurance Coverage

The coverage of HCPCS code G9660 may vary depending on the payer. Medicare considers this code to be a carrier judgment, meaning that coverage is determined by the individual Medicare Administrative Contractor (MAC) based on their local coverage policies. Other insurance providers may have their own guidelines for coverage. It is essential for healthcare providers to verify coverage with the specific payer to ensure proper reimbursement.

8. Examples

Here are five examples of when HCPCS code G9660 should be billed:

1. An 88-year-old patient presents with iron deficiency anemia, and a colonoscopy is performed to investigate the cause.
2. A 90-year-old patient experiences lower gastrointestinal bleeding, leading to the performance of a colonoscopy to identify the source of bleeding.
3. An 86-year-old patient with a known history of Crohn’s disease undergoes a colonoscopy to assess the extent of inflammation in the colon.
4. A 92-year-old patient has a familial history of adenomatous polyposis, prompting a colonoscopy to screen for polyps or other abnormalities.
5. An 87-year-old patient with a diagnosis of ulcerative colitis undergoes a colonoscopy to monitor disease progression and assess the effectiveness of treatment.