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Medications Used for the Treatment of Bladder Cancer and Associated ICD-10 Coding

December 2017, Vol 7, No 12
Kristin A. Esposito, CPhT
Clinical Services Manager, RJ Health Systems

This detailed article of codes related to bladder cancer is intended to assist practice managers and other healthcare providers and payers to ensure the proper use of coding and billing information associated with the treatment of patients with bladder cancer.

The following sections include:

  • Associated ICD-10-CM codes used for the classification of bladder cancer
  • Drugs that have been approved by the FDA for the treatment of bladder cancer
  • Drugs that are Compendia-listed for off-label use for bladder cancer based on clinical studies that suggest beneficial use in some cases. Please note: If a check mark appears in the FDA column, it will NOT appear in the Compendia off-label use column
  • Corresponding HCPCS/CPT® codes and code descriptions
  • Possible CPT® administration codes for the drugs

Associated ICD-10-CM Codes:

C67 Malignant neoplasm of bladder
  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
D09.0 Carcinoma in situ of bladdera
Generic (brand) name HCPCS/CPT® code—code description FDA approved for bladder cancer Compendia off-label uses for bladder cancer Possible CPT® administration codes
atezolizumab (Tecentriq) C9483 - Injection, atezolizumab, 10 mg   96413, 96415
atezolizumab (Tecentriq) J9999 - Not otherwise classified, antineoplastic drugs   96413, 96415
avelumab (Bavencio) C9491 - Injection, avelumab, 10 mg   96413, 96415
avelumab (Bavencio) J9999* - Not otherwise classified, antineoplastic drugs   96413, 96415
bacillus Calmette-Guérin (Tice BCG) 90586a - Bacillus Calmette-Guérin vaccine (BCG) for bladder cancer, live, for intravesical use   51720
carboplatin (Paraplatin) J9045 - Injection, carboplatin, 50 mg   96409, 96413, 96415
cisplatin (Platinol AQ) J9060 - Injection, cisplatin, powder or solution, per 10 mg   96409, 96413, 96415
docetaxel (Taxotere) J9171 - Injection, docetaxel, 1 mg   96413
doxorubicin HCl (Adriamycin) J9000 - Injection, doxorubicin hydrochloride, 10 mg   96409
epirubicin (Ellence) J9178 - Injection, epirubicin hydrochloride, 2 mg   96409, 96413
fluorouracil (Adrucil) J9190 - Injection, fluorouracil, 500 mg   96409
gemcitabine (Gemzar) J9201 - Injection, gemcitabine hydrochloride, 200 mg   96413
ifosfamide (Ifex) J9208 - Injection, ifosfamide, 1 gram   96413, 96415
interferon alfa-2b (Intron-A) J9214 - Injection, interferon, alfa-2b, recombinant, 1 million units   96372, 96401
methotrexate J9250 - Methotrexate sodium, 5 mg   96372, 96374, 96401, 96409, 96450
methotrexate J9260 - Methotrexate sodium, 50 mg   96372, 96374, 96401, 96409, 96450
mitomycin (Mutamycin) J9280 - Mitomycin, 5 mg   96409
mitoxantrone (Novantrone) J9293 - Injection, mitoxantrone hydrochloride, per 5 mg   96409, 96413
nivolumab (Opdivo) J9299 - Injection, nivolumab, 1 mg   96413, 96415
paclitaxel (Taxol) J9265 - Injection, paclitaxel, 30 mg   96413, 96415
pembrolizumab (Keytruda) J9271 - Injection, pembrolizumab, 1 mg   96413
pemetrexed (Alimta) J9305 - Injection, pemetrexed, 10 mg   96409
porfimer sodium (Photofrin) J9600 - Injection, porfimer sodium, 75 mg   96409
tamoxifen (Nolvadex) J8999* - Prescription drug, oral, chemotherapeutic, not otherwise specified   N/A
tamoxifen (Nolvadex) S0187 - Tamoxifen citrate, oral, 10 mg   N/A
thiotepa J9340 - Injection, thiotepa, 15 mg   51720, 96409
topotecan (Hycamtin) J9351 - Injection, topotecan, 0.1 mg   96413
vinBLAStine (Velban) J9360 - Injection, vinblastine sulfate, 1 mg   96409
vinCRIStine (Vincasar PFS) J9370 - Vincristine sulfate, 1 mg   96409
valrubicin (Valstar) J9357 - Injection, valrubicin, intravesical, 200 mg   51720
aThis drug is specific (and is the only drug specific) for carcinoma in situ of bladder.
*When billing a nonclassified medication using a CMS 1500 claim form you must include both the HCPCS code (eg, J9999 Tecentriq) in Item 24D and the drug name, strength, and NDC (National Drug Code) in Item 19 or 24A shaded area to ensure appropriate reimbursement.
Please note: check with your payer regarding correct placement of Medication Information in Item 19 or 24A shaded area.
• HCPCS Level II Expert 2017
Current Procedural Terminology (CPT®) 2017
CPT® Copyright © 2017 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association
ICD-10-CM Professionals Edition Volume 1 & 2 2017
• FDA-approved indication (product prescribing information)
• Compendia references available upon request
• powered by RJ Health Systems International, LLC, Rocky Hill, CT
• CMS (Centers for Medicare & Medicaid Services)
HCPCS indicates Healthcare Common Procedure Coding System.

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