Urology Coding Alert

Question: Can you explain to me how to code a full-vial dose (50 mg) of BCG treatment for bladder instillation? Only reporting J9030 does not seem to work for our insurers.

Wyoming Subscriber

Answer: First, begin with your instillation code of 51720 (Bladder instillation of anticarcinogenic agent (including retention time)). Then add your medication code J9030 (BCG live intravesical instillation, 1 mg).

Note: Billing HCPCS code J9030 only once represents giving a single milligram of the medication; under the Medicare Physician Fee Schedule (PFS), you’ll get paid $2.82 for only one milligram. Because the urologist administered a 50-mg dose, you’ll need to code for 50 units of J9030. In box 24G, the unit column, or the equivalent box in your electronic health record (EHR) enter 50.

Also remember that for some payers you cannot report a HCPCS code with a fraction of a unit. Guidelines state that fractional units of drugs should be rounded up to the next whole number for coding purposes. This would occur when you split doses of BCG between 3 patients (17 units each) with intravesical instillation all on the same day using one vial.