Example A — Office/ASC minor recurrence (<0.5 cm)
Clinical: 0.4 cm papillary LG Ta lesion on posterior wall; lesion fulgurated.
Code(s): 52224.
Dx: C67.x site-specific.

Example B — TURBT + immediate mitomycin
Clinical: Two recurrent LG Ta tumors, 1.5 cm and 0.8 cm, completely resected; immediate intravesical mitomycin instilled (40 mg).
Code(s): 52234 (largest lesion 1.5 cm), 51720 (instillation), drug HCPCS per payer (e.g., J9280 units tied to dose).
Dx: C67.x; Z51.11.

Example C — Induction BCG visit (no cystoscopy)
Clinical: Weekly intravesical BCG induction without cystoscopy.
Code(s): 51720 + payer-active BCG HCPCS and units.
Dx: Z51.12 ± C67.x (when treating active disease).

Example D — ZUSDURI™ instillation
Clinical: Office instillation 75 mg (56 mL) for recurrent LG-IR NMIBC.
Code(s): 51720 (administration) + drug billed per payer guidance (often J9999) with NDC/dose/units in the claim note.
Dx: Z51.11 ± C67.x.

• Largest tumor size, number, and location(s)
• Complete vs incomplete resection; hemostasis; complications (if any)
• Specimen details including whether detrusor muscle is present
• Recurrence context and risk category (intermediate-risk recurrent LG Ta)

• Drug name, dose, route (intravesical), volume (if relevant)
• Dwell/retention time and tolerance/side effects
• Medical necessity (active disease vs adjuvant therapy)

• NDC, drug name, route, dose given
• Wastage documentation (when applicable and permitted)
• Miscellaneous code narrative elements required by payer

Box 19:
Document NDC, drug name, route, dose given, and wastage (when applicable and permitted). Use your payer’s required format.

Example: 75 mg administered from an 80 mg vial with 5 mg wastage documented.
72493010603 ZUSDURI Instillation ME75 ME5JW

TURBT/fulguration selection rule: When multiple tumors are treated, select the code based on the largest lesion size treated in that session and document total tumor burden.

• 52000 – Cystourethroscopy (diagnostic)

• 52204 – Cystourethroscopy with biopsy
• 52214 – Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands
• 52224 – Cystourethroscopy with fulguration/treatment of minor lesion(s) <0.5 cm, with or without biopsy

• 52234 – Small tumor(s) 0.5–2.0 cm; fulguration and/or resection
• 52235 – Medium tumor(s) 2.0–5.0 cm; fulguration and/or resection
• 52240 – Large tumor(s) >5.0 cm; fulguration and/or resection

• 51720 – Bladder instillation (administration)

Drug supply: Bill drug supply separately from administration. Use payer-accepted HCPCS and units tied to dose. (Box 19 / NDC documentation example and scenarios are in the Overview tab.)

• Mitomycin (traditional vials) – J9280 (Injection, mitomycin, 5 mg)
• Gemcitabine – J9201 (Injection, gemcitabine HCl, 200 mg)
• BCG – Verify current MAC/plan policy; use payer-active J-code and units.
• Mitomycin for Intravesical Solution (ZUSDURI™) – commonly billed using J9999 (miscellaneous antineoplastic) when payer guidance requires; confirm MAC/plan guidance and follow NDC/units rules.
  Dose (per label reference in your content): 75 mg (56 mL) once weekly x 6 via intravesical instillation; supplied as a kit.

• Many transurethral bladder procedures are commonly treated as 0-day global/endoscopic/minor; verify per your MAC fee schedule for each code.

Use C67.x site-specific malignant neoplasm codes and add encounter Z-codes as appropriate.

• C67.0 – Malignant neoplasm of trigone of bladder
• C67.1 – Malignant neoplasm of dome of bladder
• C67.2 – Malignant neoplasm of lateral wall of bladder
• C67.3 – Malignant neoplasm of anterior wall of bladder
• C67.4 – Malignant neoplasm of posterior wall of bladder
• C67.5 – Malignant neoplasm of bladder neck
• C67.6 – Malignant neoplasm of ureteric orifice
• C67.7 – Malignant neoplasm of urachus
• C67.8 – Malignant neoplasm of overlapping sites of bladder
• C67.9 – Malignant neoplasm of bladder, unspecified

• Z51.11 – Encounter for antineoplastic chemotherapy (e.g., mitomycin, gemcitabine)
• Z51.12 – Encounter for antineoplastic immunotherapy (e.g., BCG)
• Z85.51 – Personal history of malignant neoplasm of bladder (surveillance when no active disease)

Note: ICD-10-CM does not capture grade/stage—keep these in the clinical documentation.

Ensure these are explicit in the note/op note:

• Pathology & Stage/Grade: e.g., Ta, low-grade (no CIS). Include variant histology, lymphovascular invasion (if present), and whether detrusor muscle is present in specimen.
• Tumor Burden: size (cm) of largest tumor, number (solitary vs. multifocal), and location(s).
• Recurrence History: date of prior TURBT(s), time since last recurrence, and response/tolerance to prior intravesical therapy with start/stop dates.
• Resection Quality: complete resection vs. residual disease suspected; hemostasis achieved.
• Immediate Post-op Instillation (if given): agent, dose, route (intravesical), and dwell/retention time.
• Planned Course: induction/maintenance schedule or re-TURBT plan; surveillance interval.
• Medical Necessity: symptoms (e.g., hematuria), cystoscopy findings, guideline risk category (intermediate-risk, recurrent LG Ta), and why intervention is required now.

Checklist – What to Include in the Op/Procedure Note

• Largest tumor size and number; location(s)
• Complete vs. incomplete resection; detrusor muscle present/absent
• Hemostasis achieved; complications (if any)
• Agent/dose/units/retention for any intravesical therapy
• Risk category and planned surveillance interval

Practice Tips

• Standardize template phrases for size/number/location and agent/dose/dwell time to reduce denials.
• When multifocal, document largest size + aggregate burden; choose the code off the largest lesion.
• Align HCPCS units and payer-required NDC reporting to the actual dose administered.

• Biopsy bundling: 52204 may be bundled into certain lesion-treatment codes (e.g., 52224). Biopsy may be separately reportable with size-based TURBT codes (52234–52240) only when performed on a distinct lesion or separate-location mapping. Verify NCCI edits and payer policy.
• Single code for multiple tumors: Choose based on the largest lesion treated and document total tumor burden.
• Modifier –22: Consider when complexity/time is well beyond typical (e.g., extensive multifocal disease). Justify with clear operative detail.
• Laterality modifiers (LT/RT): Not applicable to bladder (single organ).
• Claims narrative: For “miscellaneous” drug codes, ensure payer-required narrative/NDC/dose documentation is present (see Overview tab).

Facility charge capture commonly includes:

• Procedure/OR services: charge capture aligned to the performed endoscopic service (e.g., biopsy/fulguration/TURBT).
• Supplies: catheters/irrigation/sterile supplies per facility policy and packaging rules.
• Intravesical therapy: administration workflow + drug/biologic supply when separately payable per payer rules.
• Drug/biologic billing: use payer-accepted HCPCS and units; maintain NDC and dose documentation where required (see Overview tab for a Box 19/NDC example format).

Common facility diagnosis patterns:

• Active treatment: C67.x site-specific bladder cancer (and add encounter Z-codes when payer rules or your internal policy supports sequencing for infusion/instillation encounters).
• Chemo encounter: Z51.11 (e.g., mitomycin, gemcitabine).
• Immunotherapy encounter: Z51.12 (e.g., BCG).
• Surveillance when no active disease: Z85.51 (history of bladder cancer) as appropriate.

Reminder: ICD-10 does not encode grade; ensure clinical documentation clearly states grade/risk category.

• Procedure performed: clear operative report/procedure note supports the correct facility charge/APC grouping.
• Tumor details: largest size, number, and locations support TURBT/fulguration intensity and defensibility.
• Drug/biologic details: name, dose, route (intravesical), dwell time, NDC (when required), wastage (when permitted and required).
• Medical necessity: recurrence history, guideline risk category, and why the service is required now.

• Packaging/Status indicators: some drugs/supplies may be packaged depending on payer and setting.
• Separate payment vs. bundled: confirm whether intravesical drug supply is separately payable for your payer/site of service.
• Denial prevention: missing NDC/dose/units alignment is a common root cause—use a consistent claim-note process (see Overview tab).
• Payer variance: facility billing requirements often differ between Medicare, Medicare Advantage, and commercial payers—standardize internally but validate externally.