Treatment Categories
Pharmaceutical / Device
Tools
Overview
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.
-
This approach is designed to treat any residual disease that may remain after visible tumor resection.
-
-
-
If the tumor is unresectable via endoscopic means:
-
Chemoablation is initiated directly without resection.
-
The goal in this case is to spare the kidney by treating the unresectable disease in a non-surgical manner using JELMYTO.
-
- Open treatment options include: radical nephrectomy, partial nephrectomy, nephroureterectomy, and partial or total ureterectomy.
Additional Resources from UroGen
(PRS Vetted and Approved)
Physician Office Coding
CPT and HCPCS Codes:
Billing, coding, and reimbursement for JELMYTO® (mitomycin) for pyelocalyceal solutions
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
ICD-10 Codes:
| 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 |
Documentation for Reimbursement Tips
If billing for Jelmyto make sure you include the amount used and a separate note indicating the amount discarded/waste.
This information has been a target of the Recovery Audit Contractor (RAC) audits.
Facility Coding
Ambulatory Surgical Center (ASC)*
| 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 |
| J9281-JW | JW modifier for wastage |
*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.
Hospital Outpatient Department (HOPD)*
| 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 |
| J9281-JW | JW modifier for wastage |
*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.
Physician Billing and Coding in a Facility
Code |
Description |
|---|---|
| 52005 | Cystourethroscopy, with ureteral catheterization |
| 74420-26* | Urography, retrograde, with or without KUB |
*if performed
