How To Use CPT Code 51555

CPT 51555 describes a complex cystectomy procedure that involves the surgical removal of a portion of the urinary bladder. This article will provide an overview of CPT code 51555, including its official description, the procedure itself, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 51555?

CPT 51555 is used to describe a complex cystectomy procedure performed by a healthcare provider. This procedure involves the surgical removal of a part of the urinary bladder. It is considered complex when there are complicating factors such as prior radiation therapy, previous surgery, or the location of the tumor or diseased tissues is difficult to reach. The most common reason for performing this procedure is to treat bladder cancer.

2. Official Description

The official description of CPT code 51555 is: ‘Cystectomy, partial; complicated (eg, postradiation, previous surgery, difficult location).’ This code is used when the provider performs a complex cystectomy procedure to surgically remove a portion of the urinary bladder due to complicating factors.

3. Procedure

1. The healthcare provider begins by making an incision in the skin of the abdomen overlying the urinary bladder.
2. They then dissect through the subcutaneous tissue or just under the skin and muscles to reach the bladder.
3. Once the bladder is identified, the provider makes an incision into the bladder wall to visualize the tumor or any other diseased tissues that need to be removed.
4. The tumor or damaged tissue of the bladder wall, along with a margin of normal appearing tissue, is excised.
5. The provider then closes the bladder in two layers using sutures to prevent urine leakage and abscess formation.
6. A catheter is placed to drain urine from the bladder.
7. The provider ensures that all bleeding is stopped, places a drain, and closes the abdominal wound by suturing the layers of tissue together.
8. The drainage tube and catheter are typically removed after five days.

4. Qualifying circumstances

CPT 51555 is used when the cystectomy procedure is complicated by factors such as prior radiation therapy, previous surgery, or the difficult location of the tumor or diseased tissues. These complicating factors make the procedure more challenging and require additional expertise and care from the healthcare provider.

5. When to use CPT code 51555

CPT code 51555 should be used when a complex cystectomy procedure is performed, involving the surgical removal of a portion of the urinary bladder. It is important to ensure that the procedure meets the qualifying circumstances, such as prior radiation therapy, previous surgery, or a difficult location of the tumor or diseased tissues. If the procedure is simple and does not involve these complicating factors, CPT code 51550 should be used instead.

6. Documentation requirements

To support a claim for CPT 51555, the healthcare provider must document the following information:

• The reason for the cystectomy procedure and the presence of complicating factors
• A detailed description of the surgical technique used
• The date and duration of the procedure
• The specific tissues or tumor excised during the procedure
• Any additional procedures performed during the same operative session
• Any complications or unexpected findings encountered during the procedure
• The patient’s response to the procedure and any post-operative care provided
• The provider’s signature and credentials

7. Billing guidelines

When billing for CPT 51555, it is important to ensure that the procedure meets the criteria for a complex cystectomy with complicating factors. The healthcare provider should use the appropriate CPT code based on the specific circumstances of the procedure. It is also important to follow any additional billing guidelines provided by insurance payers or regulatory bodies.

8. Historical information

CPT code 51555 was added to the Current Procedural Terminology system on January 1, 1990. The code has not undergone any updates since its addition. In 2017, it was added to the Inpatient Only (IPO) list for Medicare reimbursement purposes.

9. Examples

1. A healthcare provider performs a complex cystectomy procedure on a patient who previously underwent radiation therapy for bladder cancer.
2. A surgeon performs a partial cystectomy on a patient who had a previous surgery to remove a bladder tumor.
3. A urologist performs a complex cystectomy on a patient with a bladder tumor located in a difficult-to-reach location.
4. A healthcare provider performs a complex cystectomy on a patient with bladder cancer who has previously undergone multiple surgeries.
5. A surgeon performs a partial cystectomy on a patient with bladder cancer who has received prior radiation therapy.
6. A urologist performs a complex cystectomy on a patient with a bladder tumor located near critical structures, making the procedure more challenging.
7. A healthcare provider performs a complex cystectomy on a patient with bladder cancer who has a history of previous surgeries and radiation therapy.
8. A surgeon performs a partial cystectomy on a patient with a bladder tumor located in a difficult-to-access area.
9. A urologist performs a complex cystectomy on a patient with bladder cancer who has a history of prior surgeries and radiation therapy.
10. A healthcare provider performs a complex cystectomy on a patient with bladder cancer who has a tumor located near the ureter, making the procedure more complex.