Urology Coding Alert

Question: How should I code for BCG treatments? Should I use CPT 90586 rather than J9031 ? Do I use the instillation code also? Virginia Subscriber Answer: You should report the appropriate J codes for the drug your urologist uses during a bladder instillation. You should report Bacille Calmette-Guerin (BCG) with J9031 (BCG live [intravesical], per instillation) for the full vial, including any portion that was instilled and any wasted portion. Additionally: For bladder instillation of anticarcinogenic agents like BCG, you should report 51720 (Bladder instillation of anticarcinogenic agent [including retention time]). Pointer: The diagnosis you report for the instillations should be 233.7 (Carcinoma in situ of breast and genitourinary system, bladder) or 188.x(Malignant tumor of bladder). Most payers will accept these diagnoses as proof of medical necessity for the instillations, but usually will not accept V10.51 (Personal history of malignant neoplasm, urinary organs, bladder). CPT coding policy dictates that [...]