How To Use CPT Code 51585

CPT 51585 describes the complete removal of the urinary bladder, adjoining organs, and pelvic lymph nodes bilaterally, along with the re-routing of urine through either a ureterosigmoidostomy or ureterocutaneous transplantation. 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 51585?

CPT 51585 can be used to describe the complete removal of the urinary bladder, surrounding organs, and pelvic lymph nodes bilaterally. This procedure is typically performed to treat bladder cancer that is found in multiple areas of the bladder or to address cancer recurrence. It also involves the re-routing of urine through either a ureterosigmoidostomy or ureterocutaneous transplantation.

2. Official Description

The official description of CPT code 51585 is: ‘Cystectomy, complete, with ureterosigmoidostomy or ureterocutaneous transplantations; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes.’

3. Procedure

1. The provider places a Foley catheter in the urethra and inflates the balloon with sterile saline.
2. An incision is made from the navel to the pubic bone to access the abdominal and pelvic cavity.
3. The provider examines the extent of the disease and removes the entire bladder, along with any attached tissues and surrounding organs.
4. In female patients, the provider may also remove the uterus, ovaries, fallopian tubes, and part of the vagina.
5. In male patients, the provider may remove the prostate, seminal vesicles, and possibly the vas deferens.
6. Pelvic lymph nodes are dissected and removed for evaluation.
7. A method of urinary diversion is created, either by implanting a ureter into the colon (ureterosigmoidostomy) or joining the urethra to the skin (ureterocutaneous transplantation).
8. The incisions are closed, and a drainage tube and catheter are inserted.

4. Qualifying circumstances

CPT 51585 is performed on patients with bladder cancer that is present in multiple areas of the bladder or in cases of cancer recurrence. The procedure involves the complete removal of the bladder, surrounding organs, and pelvic lymph nodes bilaterally. It also includes the re-routing of urine through either a ureterosigmoidostomy or ureterocutaneous transplantation.

5. When to use CPT code 51585

CPT code 51585 should be used when a complete cystectomy is performed, along with bilateral pelvic lymphadenectomy and the re-routing of urine through either a ureterosigmoidostomy or ureterocutaneous transplantation. This code should be used for the entire procedure, including all necessary components.

6. Documentation requirements

To support a claim for CPT 51585, the provider must document the following information:

• Patient’s diagnosis and the need for a complete cystectomy
• Details of the procedure, including the specific approach used (ureterosigmoidostomy or ureterocutaneous transplantation)
• Date of the procedure
• Extent of the disease and any additional findings
• Specific organs and lymph nodes removed
• Description of the method of urinary diversion
• Details of any complications or additional procedures performed
• Signature of the provider

7. Billing guidelines

When billing for CPT 51585, ensure that the complete cystectomy, bilateral pelvic lymphadenectomy, and the re-routing of urine through either a ureterosigmoidostomy or ureterocutaneous transplantation are performed. This code should not be reported with other codes for partial cystectomy or lymphadenectomy procedures. Follow the appropriate coding guidelines and modifiers for accurate billing.

8. Historical information

CPT 51585 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 billing purposes.

9. Examples

1. A patient with bladder cancer undergoes a complete cystectomy, bilateral pelvic lymphadenectomy, and ureterosigmoidostomy for urinary diversion.
2. A recurrent bladder cancer patient requires a complete cystectomy, bilateral pelvic lymphadenectomy, and ureterocutaneous transplantation for urinary diversion.
3. A patient with bladder cancer undergoes a complete cystectomy, bilateral pelvic lymphadenectomy, and ureterosigmoidostomy, along with the removal of surrounding organs.
4. A bladder cancer patient requires a complete cystectomy, bilateral pelvic lymphadenectomy, and ureterocutaneous transplantation, along with the removal of adjacent tissues.
5. A patient with bladder cancer undergoes a complete cystectomy, bilateral pelvic lymphadenectomy, and ureterosigmoidostomy, with the removal of the uterus and fallopian tubes in a female patient.
6. A recurrent bladder cancer patient requires a complete cystectomy, bilateral pelvic lymphadenectomy, and ureterocutaneous transplantation, with the removal of the prostate and seminal vesicles in a male patient.
7. A patient with bladder cancer undergoes a complete cystectomy, bilateral pelvic lymphadenectomy, and ureterosigmoidostomy, with the removal of the uterus, ovaries, and part of the vagina in a female patient.
8. A bladder cancer patient requires a complete cystectomy, bilateral pelvic lymphadenectomy, and ureterocutaneous transplantation, with the removal of the prostate, seminal vesicles, and vas deferens in a male patient.