How To Use CPT Code 51020

CPT 51020 describes a surgical procedure involving the incision or creation of an opening in the urinary bladder to access abnormal tissue. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 51020?

CPT 51020 can be used to describe a surgical procedure in which the provider makes an incision into the urinary bladder or creates a connection between the bladder and the skin. This procedure is performed to access and treat abnormal tissue within the bladder. It may involve the use of fulguration, which is the destruction of tissue using high-frequency current, or the insertion of radioactive material to destroy the abnormal tissue.

2. Official Description

The official description of CPT code 51020 is: ‘Cystotomy or cystostomy; with fulguration and/or insertion of radioactive material.’

3. Procedure

1. The provider prepares the patient for the procedure, ensuring appropriate anesthesia and prepping the surgical site.
2. An incision is made in the lower abdomen, and the provider locates the urinary bladder.
3. The bladder is checked for urine, which is drained if present.
4. An incision is made into the urinary bladder, allowing access to the abnormal tissue.
5. The abnormal tissue is destroyed using fulguration or by placing a radioactive substance in the bladder cavity.
6. The provider sutures the urinary bladder wall to close the incision and stop any bleeding.
7. If a cystostomy was performed, the tube is sutured in place.
8. The provider closes the abdominal wound by suturing the soft tissue layers.

4. Qualifying circumstances

CPT 51020 is used when there is a need to access and treat abnormal tissue within the urinary bladder. This procedure may be performed for various conditions, such as bladder tumors or other abnormalities. It is important to note that the procedure should be performed by a qualified healthcare professional with the necessary expertise in cystotomy or cystostomy procedures.

5. When to use CPT code 51020

CPT code 51020 should be used when the provider performs a cystotomy or cystostomy procedure with fulguration and/or insertion of radioactive material. It is important to accurately document the specific details of the procedure to support the use of this code.

6. Documentation requirements

To support a claim for CPT 51020, the provider must document the following information:

• Patient’s diagnosis or indication for the procedure
• Details of the procedure performed, including the use of fulguration and/or insertion of radioactive material
• Date of the procedure
• Any additional findings or complications encountered during the procedure
• Details of any additional procedures performed, if applicable
• Signature of the performing provider

7. Billing guidelines

When billing for CPT 51020, ensure that the procedure meets the specific requirements outlined in the code description. It is important to accurately document the procedure and any additional services provided. Additionally, be aware of any specific payer guidelines or requirements for reporting this code.

8. Historical information

CPT 51020 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A urologist performs a cystotomy procedure with fulguration to treat a bladder tumor in a patient.
2. A surgeon creates a cystostomy to provide ongoing drainage for a patient with a recurrent bladder abscess.
3. A urologist performs a cystotomy procedure with the insertion of radioactive material to treat a patient with non-invasive bladder cancer.
4. A provider performs a cystostomy with the removal of a bladder stone in a patient with urinary retention.
5. A surgeon performs a cystotomy procedure with the repair of a bladder fistula in a patient with a history of pelvic surgery.
6. A urologist performs a cystostomy with ureteral reimplantation to correct a congenital abnormality in a pediatric patient.
7. A provider performs a cystotomy procedure with fulguration to treat a patient with interstitial cystitis.
8. A surgeon creates a cystostomy to provide long-term access for intravesical chemotherapy in a patient with recurrent bladder cancer.
9. A urologist performs a cystotomy procedure with the removal of a foreign body in a patient who accidentally inserted a foreign object into the bladder.
10. A provider performs a cystostomy with the repair of a bladder fistula and ureteral reimplantation in a patient with complex urological abnormalities.