The alternate route travels through Nowata while the main highway bypasses the town.

The business route northern terminus is the junction of US-169 and 6th Avenue in Garnett.

The spur route follows an old alignment of US 169 into the city center of Smithville, ending at Main Street.

Iowa 7 had recently been truncated to its current eastern end at US 169, and US 20 had been rerouted onto a new freeway south of Fort Dodge.

Since both routes had viaducts over the Des Moines River, officials in Fort Dodge wanted the Iowa Department of Transportation to maintain the bridges.

However, in early 2015, a bridge was made over US 169, gaining the US 169 Business signage a year later.