Overview
ENTER TREATMENT CATEGORY NAME HERE
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Upper Tract Urothelial Cancer (UTUC) is a rare malignancy occurring in the lining of the upper urinary tract,
involving the renal pelvis and ureters. Accurate documentation, coding, and billing are essential for ensuring
proper reimbursement, compliance, and optimal patient management.
Patients with either newly diagnosed or recurrent upper tract urothelial tumors are first evaluated for
endoscopic manageability. Based on that assessment, treatment options are as follows:
-
If the tumor is endoscopically manageable
(Either low- or higher-volume, and whether unifocal or multifocal)
- Visible disease is resected or ablated through endoscopic procedures.
-
Post-resection, chemoablation is used:
- JELMYTO is administered once weekly for six weeks.
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This approach is designed to treat any residual disease that may remain after visible tumor resection.
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If the tumor is unresectable via endoscopic means
- Chemoablation is initiated directly without resection.
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The goal in this case is to spare the kidney by treating the unresectable disease in a non-surgical manner
using JELMYTO.
Physician Coding
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ENTER SHORT OVERVIEW / CONTEXT HERE. This can be 2–4 sentences that explain what this page is about.
ENTER ACCORDION DROP-DOWN INFORMATION HERE:
| Code |
Description |
| 50557 |
Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with or without biopsy |
| 50562 |
Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with resection of tumor |
| 50576 |
Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with or without biopsy |
| 52354 |
Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with biopsy and/or fulguration of ureteral or renal pelvic lesion |
| 52355 |
Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with resection of ureteral or renal pelvic tumor |
- ENTER BULLET #1
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- ENTER BULLET #3
ENTER ACCORDION DROP-DOWN INFORMATION HERE:
Retrograde Approach Using Cystoscope
| Code |
Description |
| 52005 |
Cystourethroscopy, with ureteral catheterization |
| 74420* |
Urography, retrograde, with or without KUB |
| J9281 |
Mitomycin pyelocalyceal instillation, 1 mg |
| J9281-JW |
JW modifier for wastage |
*If performed
Antegrade approach via nephrostomy tube
| Code |
Description |
| 50391 |
Instillation of therapeutic agent into renal pelvis and/or ureter through established nephrostomy tube |
| 50431* |
Injection procedure for antegrade nephrostogram and/or ureterogram, complete diagnostic procedure including imaging guidance (eg, ultrasound and fluoroscopy), and all associated radiological supervision and interpretation; existing access |
| 74420* |
Urography, retrograde, with or without KUB |
| J9281 |
Mitomycin pyelocalyceal instillation, 1 mg |
| J9281-JW |
JW modifier for wastage |
*If performed
ENTER ACCORDION DROP-DOWN INFORMATION HERE:
| Code |
Description |
| C65.1 |
Malignant neoplasm of right renal pelvis |
| C65.2 |
Malignant neoplasm of left renal pelvis |
| C66.9 |
Malignant neoplasm of unspecified ureter |
| C66.1 |
Malignant neoplasm of right ureter |
| C66.2 |
Malignant neoplasm of left ureter |
| C68.9 |
Malignant neoplasm of urinary organ, unspecified |
ENTER ACCORDION DROP-DOWN INFORMATION HERE:
If billing for Jelmyto make sure you include the amount used and the amount discarded. This information has been a target of the Recovery Audit Contractor (RAC) audits.
ENTER ACCORDION DROP-DOWN INFORMATION HERE:
The patient was taken to the operating room and placed in the dorsal lithotomy position under general anesthesia. After appropriate sterile preparation and draping, a cystourethroscopy was performed.
The right ureteral orifice was identified, and a guidewire was advanced into the ureter under fluoroscopic guidance. A ureteroscope was then introduced over the wire and advanced up the ureter and into the renal pelvis.
A papillary tumor was visualized in the renal pelvis. Using a biopsy forceps and laser fiber, the tumor was carefully resected and ablated in a piecemeal fashion, with care taken to preserve surrounding normal tissue. All visible tumor was removed. Biopsy specimens were sent to pathology for evaluation. The collecting system was inspected post-resection and appeared hemostatic with no evidence of perforation.
How would you code this?
Answer: 52355
ENTER ACCORDION DROP-DOWN INFORMATION HERE:
Patient is being seen in the ASC today for instillation of JELMYTO (mitomycin for pyelocalyceal solution) as part of treatment for low-grade upper tract urothelial carcinoma. A total of 39 mg was instilled into the renal pelvis via a ureteral catheter with retrograde urography. The procedure was well-tolerated with no immediate complications. Following administration, 41 mg of the Jelmyto was discarded.
How would you code this?
Answer:
Physician Coding
52005
74420
J9281 39
J9281-JW 41
Facility Coding*
| Code |
ASC Status Indicator |
APC |
| C9789 |
G2 |
1559 |
| Code |
ASC Status Indicator |
APC |
| J9281 |
K2 |
9374 |
*Coding will vary by payer. Many Commercial Payers and Medicare Advantage Plans will not recognize C-codes.
J-codes may not be processed by some plans.
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ENTER TEXT HERE.
ENTER ACCORDION DROP-DOWN INFORMATION HERE:
ENTER TEXT HERE.
Facility Coding
Facility Coding for Chemoablation Jelmyto
ENTER FACILITY CODING OVERVIEW HERE.
ENTER ACCORDION DROP-DOWN INFORMATION HERE:
| Code |
Description |
ASC Status Indicator |
APC |
| C9789 |
Instillation of anti-neoplastic pharmacologic/biologic agent into renal pelvis, any method, including all imaging guidance, including volumetric measurement if performed |
G2 |
1559 |
| Code |
Description |
ASC Status Indicator |
APC |
| J9281 |
Mitomycin pyelocalyceal instillation, 1 mg |
K2 |
9374 |
*Coding will vary by payer. Many Commercial Payers and Medicare Advantage Plans will not recognize C-codes. J-codes may not be processed by some plans.
ENTER ACCORDION DROP-DOWN INFORMATION HERE:
| Code |
Description |
HOPD Status Indicator |
APC |
| C9789 |
Instillation of anti-neoplastic pharmacologic/biologic agent into renal pelvis, any method, including all imaging guidance, including volumetric measurement if performed |
T |
1559 |
| J9281 |
Mitomycin pyelocalyceal instillation, 1 mg |
K |
9374 |
*Coding will vary by payer. Many Commercial Payers and Medicare Advantage Plans will not recognize C-codes. J-codes may not be processed by some plans.
ENTER ACCORDION DROP-DOWN INFORMATION HERE:
| Code |
Description |
| 52005 |
Cystourethroscopy, with ureteral catheterization |
| 74420-26 |
Urography, retrograde, with or without KUB |
| J9281 |
Mitomycin pyelocalyceal instillation, 1 mg |
| J9281-JW |
JW modifier for wastage |
