How To Use CPT Code 51590

CPT 51590 describes the complete removal of the urinary bladder and the creation of either a ureteroileal conduit or a sigmoid bladder, including the anastomosis of the intestine. This article will provide an overview of CPT code 51590, including its official description, the procedure involved, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples.

1. What is CPT Code 51590?

CPT 51590 is used to describe a surgical procedure in which the entire urinary bladder is removed. The provider may choose to create a ureteroileal conduit or a sigmoid bladder to maintain the outflow of urine. The procedure involves cutting a portion of the intestine, such as the ileum, and suturing the ureters to divert urine into the conduit or bladder. This code encompasses the complete removal of the bladder and the necessary anastomosis of the intestine.

2. Official Description

The official description of CPT code 51590 is: ‘Cystectomy, complete, with ureteroileal conduit or sigmoid bladder, including intestine anastomosis.’

3. Procedure

1. The provider begins by making an incision below the navel in the midline and separating and retracting the rectus abdominis muscle.
2. After exposing the ureters, the provider divides them distally and ties them with long tailed sutures for identification.
3. The provider then mobilizes the bladder, ligates the blood vessels, and removes the bladder.
4. To create a ureteroileal conduit, the provider isolates a portion of the ileum and sutures the cut ends of the intestine together to reestablish bowel continuity.
5. Windows are created in the posterior layer of peritoneum, and the distal ends of the ureters are drawn through these windows and sutured to the ileal conduit to divert urine into it.
6. To create a sigmoid bladder, the provider replaces the bladder with a U or J shaped segment of sigmoid colon and sutures the distal end of the ureters onto it.
7. The sigmoid bladder is then anastomosed to the urethra for the outflow of urine.
8. Drains are placed, and the wound is closed in layers.

4. Qualifying circumstances

CPT 51590 is performed when the complete removal of the urinary bladder is necessary due to severe trauma or malignancy. The creation of a ureteroileal conduit or sigmoid bladder is done to facilitate urine excretion. The procedure is typically performed by a qualified healthcare professional who has the necessary expertise in urological surgery.

5. When to use CPT code 51590

CPT code 51590 should be used when the provider performs a complete cystectomy and creates either a ureteroileal conduit or a sigmoid bladder, including the anastomosis of the intestine. This code accurately represents the comprehensive nature of the procedure and the associated work involved.

6. Documentation requirements

To support a claim for CPT 51590, the provider must document the following information:

• Patient’s diagnosis necessitating the complete cystectomy
• Details of the procedure performed, including the creation of a ureteroileal conduit or sigmoid bladder
• Date of the surgery
• Start and end time of the procedure
• Any additional procedures or interventions performed
• Any complications encountered during the surgery
• Signature of the performing provider

7. Billing guidelines

When billing for CPT 51590, ensure that the procedure performed includes the complete removal of the urinary bladder and the creation of either a ureteroileal conduit or a sigmoid bladder. It is important to follow the specific documentation requirements and guidelines set forth by the payer. Additionally, be aware of any bundling or unbundling issues that may arise when reporting this code with other related procedures.

8. Historical information

CPT code 51590 was added to the Current Procedural Terminology system on January 1, 1990. Since then, there have been a few changes to the code, including updates to the description and the addition of the code to the Inpatient Only (IPO) list for Medicare in 2017.

9. Examples

1. A patient undergoes a complete cystectomy with the creation of a ureteroileal conduit for urine diversion following the diagnosis of bladder cancer.
2. A provider performs a radical cystectomy and replaces the bladder with a sigmoid bladder in a patient with severe trauma to the urinary system.
3. A complete cystectomy with the creation of a ureteroileal conduit is performed on a patient with advanced urothelial carcinoma.
4. A provider performs a cystectomy and creates a sigmoid bladder for a patient with recurrent bladder infections and non-functioning bladder.
5. A patient undergoes a complete cystectomy with the creation of a ureteroileal conduit due to the presence of a large bladder stone causing significant pain and obstruction.