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Official Description

Excision of urachal cyst or sinus, with or without umbilical hernia repair

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 51500 involves the excision of a urachal cyst or sinus, which may be performed with or without the repair of an umbilical hernia. The urachus is a fetal duct that typically closes off between the second and fourth month of gestation, transforming into the median umbilical ligament. In some cases, this duct does not fully obliterate, leading to the formation of a urachal cyst or sinus that can connect the umbilicus to the bladder. While these conditions are often asymptomatic, surgical intervention is indicated if an infection occurs. The surgical process begins with the placement of a catheter through the urethra into the bladder to facilitate access. An incision is made in the midline of the abdomen, starting just below the umbilicus and extending over the bladder. The surgeon dissects through the underlying tissues, divides the anterior rectus abdominus muscle, and exposes the urachal sinus or cyst. The procedure may also involve the repair of an umbilical hernia if present, which includes the excision of the hernia sac and closure of the abdominal wall defect. This comprehensive approach ensures the complete removal of the urachal anomaly while addressing any associated hernia, promoting optimal recovery and minimizing complications.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The excision of a urachal cyst or sinus, as described by CPT® Code 51500, is indicated in the following situations:

  • Persistent Urachal Anomaly - A urachal cyst or sinus that remains present after the typical obliteration period and may lead to complications.
  • Infection - The presence of infection in the urachal cyst or sinus necessitating surgical intervention to prevent further complications.
  • Umbilical Hernia - The presence of an umbilical hernia that may require repair during the excision of the urachal cyst or sinus.

2. Procedure

The procedure for excising a urachal cyst or sinus involves several detailed steps:

  • Step 1: Catheter Placement - A catheter is inserted through the urethra and into the bladder to facilitate access and ensure the bladder is empty during the procedure.
  • Step 2: Incision - A midline incision is made in the abdominal wall, starting just below the umbilicus and extending over the bladder to provide adequate exposure of the surgical site.
  • Step 3: Dissection - The underlying tissues are carefully dissected to expose the anterior rectus abdominus muscle, which is then divided to gain access to the urachal cyst or sinus.
  • Step 4: Exposure of the Urachal Structure - The sinus or cyst is identified and mobilized using sharp dissection, with attention to detaching any portion of the median umbilical ligament that may have formed.
  • Step 5: Bladder Preparation - The bladder is filled with sterile saline to aid in visualization and to facilitate the dissection of the urachal structure down to the bladder dome.
  • Step 6: Peritoneal Incision - The peritoneum is incised, allowing for continued mobilization of the urachal cyst or sinus towards the bladder dome.
  • Step 7: Severing Connections - All connections between the urachal cyst or sinus and the bladder dome are carefully severed, which may involve resection of a bladder cuff that is subsequently repaired with sutures.
  • Step 8: Complete Excision - The urachal cyst or sinus is completely excised from the surrounding tissues.
  • Step 9: Umbilical Hernia Repair (if present) - If an umbilical hernia is identified, the hernia sac is exposed, and the neck of the sac is incised and lifted away from the abdominal wall. The contents of the hernia are inspected, any adhesions are severed, and the bowel is returned to the abdomen.
  • Step 10: Closure - The hernia sac is excised, and the defect in the abdominal wall is closed using sutures and/or a mesh implant as necessary. Finally, the skin and subcutaneous tissues are closed in layers to complete the procedure.

3. Post-Procedure

Post-procedure care following the excision of a urachal cyst or sinus includes monitoring for any signs of infection, managing pain, and ensuring proper wound healing. Patients may be advised to limit physical activity for a specified period to promote recovery. Follow-up appointments are typically scheduled to assess the surgical site and ensure that there are no complications, such as hernia recurrence or infection. Instructions regarding care of the incision site and any restrictions on activities will be provided to support optimal healing.

Short Descr REMOVAL OF BLADDER CYST
Medium Descr EXC URACHAL CYST/SINUS W/WO UMBILICAL HERNIA RPR
Long Descr Excision of urachal cyst or sinus, with or without umbilical hernia repair
Status Code Active Code
Global Days 090 - Major Surgery
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 2 - Payment restriction for assistants at surgery does not apply to this procedure...
Co-Surgeons (62) 1 - Co-surgeons could be paid, though supporting documentation is required...
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Hospital Part B services paid through a comprehensive APC
ASC Payment Indicator Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight.
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P1G - Major procedure - Other
MUE 1
CCS Clinical Classification 112 - Other OR therapeutic procedures of urinary tract
22 Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service.
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
53 Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
62 Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate.
80 Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).
82 Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s).
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
CR Catastrophe/disaster related
GC This service has been performed in part by a resident under the direction of a teaching physician
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