2025 HCPCS code G9659
Patient 86 or older who underwent screening colonoscopy without history of colorectal cancer or other medical reason.
Medical necessity in this context refers to the appropriateness of performing a screening colonoscopy in patients 86 or older who do not have other medical reasons to undergo such a procedure. As complications with colonoscopies increase with age, careful consideration must be given to the potential benefits and risks for each patient. This code facilitates the tracking of such cases for quality and utilization review.
The provider is responsible for determining and documenting the patient's age (86 or older), confirming the colonoscopy was for screening purposes, and ensuring there is no history of colorectal cancer or other medical conditions justifying a diagnostic colonoscopy.
In simple words: This code is used for patients 86 years or older who had a colonoscopy for screening purposes and did not have colon cancer or other medical reasons for it.
This code is reported for patients aged 86 years and older who have undergone a screening colonoscopy but do not have a history of colorectal cancer or any other valid medical justification for the procedure. This includes conditions like iron deficiency anemia, lower gastrointestinal bleeding, Crohn's disease, familial adenomatous polyposis, Lynch syndrome, inflammatory bowel disease, ulcerative colitis, abnormal findings in the gastrointestinal tract, or changes in bowel habits.
Example 1: An 87-year-old patient with no prior history of colon cancer or other GI issues undergoes a screening colonoscopy. The provider would report G9659., A 90-year-old patient with a history of anemia undergoes a colonoscopy to investigate the cause. Code G9659 would not be reported as the colonoscopy was not for screening. , An 86-year-old patient with changes in bowel habits undergoes a colonoscopy. As this not a screening colonoscopy, G9659 is not applicable.
Documentation must confirm the patient's age, the screening nature of the colonoscopy, and the absence of any history of colorectal cancer or other medical reasons justifying a diagnostic colonoscopy. Medical records should clearly establish that the procedure was performed solely for screening purposes in a patient 86 years or older without any other underlying indications.
- Specialties:Gastroenterology, General Practice, Internal Medicine, Geriatrics
- Place of Service:Ambulatory Surgical Center, On Campus-Outpatient Hospital, Off Campus-Outpatient Hospital, Office