Urology Coding Alert

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 you should use one of the above diagnoses even if your urologist administers the treatments prophylactically.

Answers to Reader Questions and You Be the Coder contributed by Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook.