How To Use CPT Code 51500

CPT 51500 describes the excision of a urachal cyst or sinus, with or without umbilical hernia repair. 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 51500?

CPT 51500 can be used to describe the surgical removal of a urachal cyst or sinus, along with the option for umbilical hernia repair. This code is used when the provider performs an excision procedure to remove the abnormal communication between the urinary bladder and the navel, known as a urachus. The provider may also correct an umbilical hernia during the same procedure.

2. Official Description

The official description of CPT code 51500 is: ‘Excision of urachal cyst or sinus, with or without umbilical hernia repair.’

3. Procedure

1. The provider ensures that any existing infection has been adequately treated.
2. After the patient is appropriately prepped and anesthetized, the provider makes a small midline incision on the lower abdomen.
3. The provider divides and retracts the underlying muscles and structures to gain a view of the urachal cyst or sinus.
4. The provider removes the urachus along with the cyst and sinus.
5. If an umbilical hernia repair is necessary, the provider enters the umbilicus and identifies the linea alba.
6. The provider opens the neck of the sac, examines and closes the contents of the sac, and may use a mesh to close large defects.
7. After achieving hemostasis, the provider closes the overlying muscles and skin in layers.

4. Qualifying circumstances

Patients eligible to undergo CPT 51500 are those with a urachal cyst or sinus that requires surgical excision. The procedure may also include umbilical hernia repair if necessary. The provider must ensure that any existing infection has been treated before performing the excision. The patient’s condition and medical history should be assessed to determine the appropriateness of the procedure.

5. When to use CPT code 51500

CPT code 51500 should be used when the provider performs the excision of a urachal cyst or sinus, with or without umbilical hernia repair. This code is appropriate when the procedure is performed on an individual patient. It should not be used for other excision procedures on the bladder that have different CPT codes.

6. Documentation requirements

To support a claim for CPT 51500, the provider must document the following information:

• Patient’s diagnosis of a urachal cyst or sinus
• Details of any existing infection and its treatment
• Date of the procedure
• Specific steps taken during the procedure, including the incision, removal of the urachus, and umbilical hernia repair if performed
• Use of mesh for closing large defects, if applicable
• Details of the closure of muscles and skin layers
• Any complications or unexpected findings during the procedure
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 51500, ensure that the procedure performed matches the description of the code. The provider should document the excision of a urachal cyst or sinus, with or without umbilical hernia repair. It is important to follow the guidelines provided by the payer for proper coding and billing. CPT code 51500 should not be reported with other codes that describe different excision procedures on the bladder.

8. Historical information

CPT 51500 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 provider performs an excision of a urachal cyst for a patient with a diagnosed urachal cyst.
2. A patient undergoes an excision of a urachal sinus, along with umbilical hernia repair, during the same procedure.
3. A provider performs an excision of a urachal cyst and corrects an umbilical hernia for a patient with both conditions.
4. An individual undergoes an excision of a urachal sinus, with subsequent closure of the overlying muscles and skin layers.
5. A provider performs an excision of a urachal cyst, with the use of mesh for closing a large defect, for a patient with a complex case.
6. A patient undergoes an excision of a urachal sinus, with subsequent umbilical hernia repair, for the treatment of both conditions.
7. A provider performs an excision of a urachal cyst and corrects an umbilical hernia, with resection of the bladder dome, for a patient with a complicated case.
8. An individual undergoes an excision of a urachal sinus, with subsequent partial cystectomy, for the treatment of a complex urachal condition.
9. A provider performs an excision of a urachal cyst, with resection of the bladder dome and partial cystectomy, along with ureteral reimplantation, for a patient with a complicated case.
10. A patient undergoes an excision of a urachal sinus, with subsequent umbilical hernia repair, complicated by unexpected findings during the procedure.