How To Use CPT Code 51595

CPT 51595 describes the complete removal of the urinary bladder, along with a bilateral pelvic lymphadenectomy. 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 51595?

CPT 51595 can be used to describe the surgical procedure in which the entire urinary bladder is removed, along with an extensive removal of bilateral pelvic lymph nodes. This code is used when the provider performs a cystectomy, which may involve creating a ureteroileal conduit or a sigmoid bladder, depending on the patient’s specific needs.

2. Official Description

The official description of CPT code 51595 is: ‘Cystectomy, complete, with ureteroileal conduit or sigmoid bladder, including intestine anastomosis; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes.’

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. Next, the provider extensively removes the lymph nodes of both sides of the pelvis, including external iliac, hypogastric, and obturator lymph nodes, while taking care not to injure the iliac vessels.
3. The provider then exposes the ureters and divides them distally, tying them with long tailed sutures for identification.
4. The bladder is mobilized, and the provider ligates the blood vessels and removes the bladder.
5. To create a ureteroileal conduit, the provider isolates a portion of the ileum and transilluminates it to ensure its vascularity.
6. The provider then draws the distal ends of both ureters through windows created in the posterior layer of peritoneum and sutures them to the ileal conduit to divert urine into it.
7. If a sigmoid bladder is created instead, 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.
8. The sigmoid bladder is then anastomosed to the urethra for outflow of urine.
9. Drains are placed, and the wound is closed in layers.

4. Qualifying circumstances

Patients who may require CPT 51595 are those who need a complete removal of the urinary bladder due to malignancy. The procedure may involve the creation of a ureteroileal conduit or a sigmoid bladder, depending on the patient’s specific needs. The provider must also perform a bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes.

5. When to use CPT code 51595

CPT code 51595 should be used when the provider performs a complete cystectomy, along with a bilateral pelvic lymphadenectomy, and creates either a ureteroileal conduit or a sigmoid bladder. This code is appropriate for cases where the entire urinary bladder needs to be removed due to malignancy.

6. Documentation requirements

To support a claim for CPT 51595, the provider must document the following information:

• Patient’s diagnosis necessitating the complete removal of the urinary bladder
• Details of the procedure performed, including whether a ureteroileal conduit or sigmoid bladder was created
• Date of the surgery
• Specific lymph nodes removed during the bilateral pelvic lymphadenectomy
• Any complications or additional procedures performed
• Signature of the provider

7. Billing guidelines

When billing for CPT 51595, ensure that the procedure performed includes the complete removal of the urinary bladder, along with a bilateral pelvic lymphadenectomy. The appropriate code should be reported based on whether a ureteroileal conduit or sigmoid bladder was created. It is important to follow the specific guidelines provided by the payer and to accurately document the details of the procedure.

8. Historical information

CPT 51595 was added to the Current Procedural Terminology system on January 1, 1990. There have been some historical changes to the code, including a code change on January 1, 2002, and its addition to the Inpatient Only (IPO) list for Medicare in 2017.

9. Examples

1. A patient with bladder cancer undergoes a cystectomy with a ureteroileal conduit creation and bilateral pelvic lymphadenectomy.
2. A provider performs a complete cystectomy with a sigmoid bladder creation and bilateral pelvic lymphadenectomy for a patient with advanced bladder malignancy.
3. A patient with recurrent bladder cancer requires a cystectomy with a ureteroileal conduit and extensive removal of pelvic lymph nodes.
4. A provider performs a cystectomy with a sigmoid bladder creation and bilateral pelvic lymphadenectomy for a patient with invasive bladder carcinoma.
5. A patient with a history of bladder cancer undergoes a cystectomy with a ureteroileal conduit and removal of bilateral pelvic lymph nodes.
6. A provider performs a complete cystectomy with a sigmoid bladder creation and extensive removal of pelvic lymph nodes for a patient with metastatic bladder cancer.
7. A patient with muscle-invasive bladder cancer requires a cystectomy with a ureteroileal conduit and bilateral pelvic lymphadenectomy.
8. A provider performs a cystectomy with a sigmoid bladder creation and bilateral pelvic lymphadenectomy for a patient with recurrent urothelial carcinoma.