Oncology & Hematology Coding Alert

Answer: You should report the appropriate J code for the drug your oncologist uses during a bladder instillation. You should report Bacille Calmette-Guerin (BCG) with J9031 (BCG live [intravesical], per instillation) as the code states “per instillation.” This code is inclusive of the quantity instilled and wasted portions, if any.

 

J9031 implies per instillation: You report one unit of J9031 for every instillation that your oncologist attempts. One or more vials may be used in a single instillation. 

 

You also bill 90586 (Bacillus Calmette-Guerin vaccine [BCG] for bladder cancer, live, for intravesical use).

 

Do not forget the bladder installation: For bladder instillation of anticarcinogenic agents like BCG, you should report 51720 (Bladder instillation of anticarcinogenic agent [including retention time]). The chemotherapeutic agent may be left in the bladder to act locally for a defined period of time before your physician drains it off the bladder. 

 

Never miss the diagnosis codes: Lastly, your reporting is incomplete without the appropriate diagnosis codes. You may see one of the following diagnosis codes as it is supported in the documentation: 

Note: You can use one of the above diagnoses even if your oncologist instills BCG prophylactically.

 

What is BCG vaccine? BCG vaccine consists of live bacteria derived from an attenuated strain of bacilli causing tuberculosis. Treatment with BCG is used to treat bladder cancer. The vaccine acts to control the tumor by hampering the growth of tumor cells. 

 

What is an intravesical administration? According to American Urological Association, intravesical administration implies direct administration of the drug into the urinary bladder. Your physician will administer the solution via a slow drip into the bladder through a urethral catheter. This allows the active agent to come in contact with the cancer cells directly and hence act locally in the bladder. 

 

You can read more on https://www.auanet.org/education/guidelines/bladder-cancer.cfm.