Summary & Overview
HCPCS C9738: Adjunctive Blue Light Cystoscopy with Fluorescent Imaging Agent
HCPCS Level II code C9738 identifies adjunctive blue light cystoscopy using a fluorescent imaging agent, billed separately in addition to the primary cystoscopic procedure. This code captures the use of blue light and agent-enhanced visualization to detect bladder lesions that may be less visible under white light alone. Nationally, the code matters because it documents use of advanced diagnostic adjuncts that can impact clinical detection rates, procedure reporting, and payer coverage decisions.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare and Medicare. Readers will find an overview of clinical context for blue light cystoscopy, typical sites of service where the adjunct is used, and what is commonly reported with the primary cystoscopy procedure. The publication summarizes billing considerations and common modifiers used with adjunctive services where available. It also highlights benchmark concepts and policy-related themes relevant to coverage and reimbursement for adjunctive imaging in urologic procedures.
The content is designed to inform coding professionals, clinicians, and policy analysts about documentation expectations and the operational context for HCPCS Level II code C9738. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code C9738 describes adjunctive blue light cystoscopy with fluorescent imaging agent, reported in addition to the primary cystoscopy procedure. This service involves using a fluorescent imaging agent and blue light technology to enhance visualization of bladder mucosa and lesions during cystoscopic evaluation.
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Service type: Adjunctive diagnostic imaging procedure performed during cystoscopy
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Typical site of service: Hospital outpatient department or ambulatory surgical center where cystoscopic procedures are performed
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult evaluated for visible or suspected bladder cancer presenting with painless gross hematuria or recurrent non‑muscle invasive bladder cancer (NMIBC) under surveillance. The patient is brought to the outpatient cystoscopy suite or ambulatory surgery center for transurethral resection of bladder tumor (TURBT) using standard white‑light cystoscopy followed by adjunctive C9738 blue light cystoscopy with an intravesical fluorescent imaging agent. The workflow: preoperative consent and allergy check; instillation of the fluorescent agent into the bladder and dwell time per manufacturer instructions (typically 60–90 minutes) while the patient waits in preop; induction of anesthesia or monitored anesthesia care depending on complexity and comorbidities; rigid or flexible cystoscopy under white light to locate lesions; activation of blue light mode and fluorescent imaging to detect additional papillary or flat lesions (carcinoma in situ) not visible on white light; targeted resection or biopsy of suspicious areas with TURBT instruments; hemostasis, final inspection with blue and white light; catheter placement as clinically indicated; recovery and postoperative instructions. Typical sites of service are the hospital outpatient department or ambulatory surgery center; the procedure is often performed by a urologist with endourology expertise.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required is substantially greater than usual for the adjunctive imaging (e.g., unusually complex instillation, extended operative time related to imaging interpretation). |