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Complete cystectomy, as defined by CPT® Code 51570, is a surgical procedure that involves the total removal of the bladder. This procedure is indicated for various medical conditions that severely affect bladder function or pose significant health risks. Common reasons for performing a complete cystectomy include malignant neoplasms, which are cancerous tumors that can invade bladder tissue; severe radiation or chemical cystitis, which is inflammation of the bladder caused by radiation therapy or chemical irritants; and refractory interstitial cystitis, a chronic condition characterized by bladder pain and frequent urination that does not respond to standard treatments. Other indications include hemorrhagic cystitis, which involves bleeding from the bladder; neurogenic bladder disease, where nerve damage affects bladder control; severe incontinence that cannot be managed by other means; trauma to the bladder; the presence of fistulas, which are abnormal connections between the bladder and other structures; upper urinary tract obstruction; and refractory urethral stricture, a narrowing of the urethra that impedes urine flow. The surgical approach typically involves an extraperitoneal technique, especially if urinary diversion has been previously established. The procedure is initiated with an incision, followed by careful dissection and removal of the bladder while preserving surrounding structures as much as possible, ensuring a thorough and complete excision of the bladder tissue.
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The complete cystectomy procedure is indicated for the following conditions:
The complete cystectomy procedure involves several critical steps to ensure the successful removal of the bladder. The process begins with the patient being positioned appropriately, followed by the administration of anesthesia. A low midline or transverse suprapubic incision is made to access the bladder. Once the incision is made, the overlying fascia is divided, allowing entry into the space of Retzius. At this point, a pelvic lymph node dissection may be performed as needed, which involves the careful removal of lymph nodes in the pelvic region to assess for any potential spread of malignancy. The fatty tissue surrounding the common iliac vessels is stripped bilaterally, and the internal and external iliac vessels are similarly cleared to the level of the circumflex iliac vein. The iliac, hypogastric, and obturator nodes are excised bilaterally to ensure comprehensive lymphatic clearance. Following the lymphadenectomy, the surgeon employs both blunt and sharp dissection techniques to separate the parietal peritoneum from the dome and posterior wall of the bladder. The superior bladder pedicles are then clamped and divided, and any remaining portions of the distal ureters are freed from surrounding structures. The dissection continues through the posterior bladder, bladder neck, and base of the bladder until the entire bladder is completely detached from all surrounding tissues. The lateral vascular pedicles are ligated and divided to prevent excessive bleeding. Finally, the urethra is divided, and the bladder is removed entirely from the body. It is important to note that if a pelvic lymphadenectomy is performed during this procedure, the appropriate coding would be CPT® Code 51575 instead of 51570.
After the complete cystectomy, patients typically require careful monitoring and management in the postoperative period. Expected recovery may involve a hospital stay for several days, during which the surgical site is observed for any signs of infection or complications. Patients may experience pain and discomfort, which can be managed with prescribed analgesics. Additionally, the patient may need to adapt to changes in urinary function, especially if urinary diversion has been performed. Follow-up appointments are essential to monitor healing and assess any further treatment needs, particularly if the cystectomy was performed due to malignancy. Patients should be educated on signs of complications, such as excessive bleeding, fever, or unusual discharge from the surgical site, and instructed to seek medical attention if these occur. Rehabilitation and support may also be necessary to help patients adjust to their new urinary function and lifestyle changes following the procedure.
| Short Descr | REMOVAL OF BLADDER | Medium Descr | CYSTECTOMY COMPLETE SEPARATE PROCEDURE | Long Descr | Cystectomy, complete; (separate procedure) | 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 | Inpatient Procedures, not paid under OPPS | 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). | 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. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 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 | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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