How To Use CPT Code 51565

CPT 51565 describes a surgical procedure that involves the partial removal of the bladder and the reimplantation of the ureter(s) into the bladder. This article will provide an overview of CPT code 51565, 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 51565?

CPT 51565 is a code used to describe a surgical procedure in which a qualified healthcare provider removes a diseased or injured portion of the bladder near the ureter(s) and then reimplants the ureter(s) into the bladder through a newly created entry point. This procedure is typically performed to address conditions such as tumors or damage to the bladder.

2. Official Description

The official description of CPT code 51565 is: ‘Cystectomy, partial, with reimplantation of ureter(s) into bladder (ureteroneocystostomy).’ This procedure involves the removal of a portion of the bladder and the reimplantation of the ureter(s) into the bladder through a newly created entry point.

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 and the lower portion of the ureter(s).
3. The provider mobilizes the bladder, ureter(s), and major blood vessels, and incises the bladder wall if necessary to visualize the tumor or damaged bladder tissues.
4. After assessing the affected tissue and its relationship to the ureteric openings in the bladder and the bladder neck, the provider removes the portion of the bladder where the tumor or damage is present.
5. The bladder defect is closed by suturing the surrounding muscles over it in two layers.
6. The provider then transects the ureter(s) and incises the free end(s) of the ureter(s).
7. They create an opening in the front portion of the bladder and place the ureter(s) through that opening.
8. This procedure may be repeated for each ureter that requires reimplantation.
9. A catheter is placed to drain urine and prevent leakage from the surgical site.
10. The provider ensures hemostasis, places a drain tube, and closes the abdominal wound by suturing the layers of tissue together.
11. The drainage tube and catheter are typically removed after five days.

4. Qualifying circumstances

CPT code 51565 is typically used for patients who require partial cystectomy and reimplantation of the ureter(s) into the bladder. This procedure is performed when there is a diseased or injured portion of the bladder near the ureter(s) that needs to be removed. It is important to note that not all bladder conditions will require this specific procedure, and the decision to perform CPT 51565 is based on the individual patient’s diagnosis and clinical presentation.

5. When to use CPT code 51565

CPT code 51565 should be used when a qualified healthcare provider performs a partial cystectomy and reimplantation of the ureter(s) into the bladder. It is important to ensure that the procedure meets the specific criteria outlined in the official description of CPT 51565. If the procedure does not involve the reimplantation of the ureter(s) into the bladder, a different CPT code should be used to accurately report the service provided.

6. Documentation requirements

To support a claim for CPT 51565, the healthcare provider must document the following information:

• Patient’s diagnosis and the need for partial cystectomy and ureter reimplantation
• Details of the procedure, including the specific bladder tissue removed and the number of ureters reimplanted
• Date of the procedure
• Start and end time of the procedure
• Any complications or unexpected findings during the procedure
• Post-operative care instructions and any follow-up appointments scheduled
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 51565, it is important to ensure that the procedure meets the specific criteria outlined in the official description. The healthcare provider performing the procedure should be qualified and experienced in performing partial cystectomies and ureter reimplantation. It is also important to follow any additional billing guidelines provided by insurance payers or regulatory bodies.

8. Historical information

CPT code 51565 was added to the Current Procedural Terminology system on January 1, 1990. In 2017, it was added to the Inpatient Only (IPO) list for Medicare reimbursement purposes.

9. Examples

1. A qualified healthcare provider performs a partial cystectomy and reimplantation of the ureter(s) into the bladder for a patient with bladder cancer.
2. A patient with a history of recurrent urinary tract infections undergoes a partial cystectomy and reimplantation of the ureter(s) into the bladder to address a structural abnormality.
3. A healthcare provider performs a partial cystectomy and reimplantation of the ureter(s) into the bladder for a patient with a congenital bladder defect.
4. A patient with a history of bladder stones undergoes a partial cystectomy and reimplantation of the ureter(s) into the bladder to remove the stones and address any associated damage.
5. A qualified healthcare provider performs a partial cystectomy and reimplantation of the ureter(s) into the bladder for a patient with interstitial cystitis.