Question 1

What is HCPCS code G9659?

Accepted Answer

HCPCS code G9659 is ">=86y scr colo nomed rsn". 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, familial adenomatous polyposis, lynch syndrome (i.e., hereditary non-polyposis colorectal cancer), inflammatory bowel disease (i.e., crohn's disease or ulcerative colitis), abnormal finding of gastrointestinal tract, weight loss, or changes in bowel habits

Question 2

What category is G9659 in?

Accepted Answer

G9659 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G9659?

Accepted Answer

Use G9659 when billing for >=86y scr colo nomed rsn. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is G9659 covered by Medicare?

Accepted Answer

Coverage for G9659 (>=86y scr colo nomed rsn) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for G9659?

Accepted Answer

Documentation for G9659 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).