The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on electrically-stimulated intravesical chemotherapy for superficial bladder cancer.


This procedure, also known as electromotive drug administration (EMDA) of intravesical chemotherapy, can be used for patients with bladder cancer, either before or after surgery. A solution including a chemotherapy drug is injected into the bladder using a thin tube inserted through the urethra. At the same time, an electrode is inserted in the bladder and other electrodes are placed on the skin of the lower abdomen. An electric current is then created with the aim of improving absorption of the chemotherapeutic drugs.

Coding recommendations

The OPCS-4 codes for Electrically stimulated intravesical instillation of chemotherapy:

M49.4 Introduction of therapeutic substance into bladder, followed by the appropriate combination of chemotherapy codes from categories X70-X73 depending on which chemotherapy regimen is administered.

Y12.3 Electrochemotherapy to lesion of organ NOC

In addition an ICD-10 code from category C67.- Malignant neoplasm of bladder orC79.1 Secondary malignant neoplasm of bladder and other and unspecified urinary organs is assigned.

Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.