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Official Description

Cystectomy, complete; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

Complete cystectomy, as described by CPT® Code 51575, is a surgical procedure that involves the removal of the entire bladder along with a bilateral pelvic lymphadenectomy. This procedure is indicated for various serious medical conditions, including malignant neoplasms, which are cancers that can affect the bladder, as well as severe radiation or chemical cystitis, which is inflammation of the bladder due to radiation or chemical exposure. Other indications for this surgery include refractory interstitial cystitis, a chronic condition causing bladder pain and frequent urination; hemorrhagic cystitis, characterized by bleeding in the bladder; neurogenic bladder disease, which affects bladder control due to nerve damage; severe incontinence; trauma to the bladder; 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 does not respond to treatment. The procedure typically employs an extraperitoneal approach when urinary diversion has been previously performed. The surgical technique involves making a low midline or transverse suprapubic incision to access the bladder, followed by a series of meticulous dissection steps to ensure complete removal of the bladder and associated lymph nodes, specifically targeting the iliac, hypogastric, and obturator nodes bilaterally.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The complete cystectomy with bilateral pelvic lymphadenectomy, as indicated by CPT® Code 51575, is performed for the following conditions:

  • Malignant Neoplasm - Cancer affecting the bladder.
  • Severe Radiation or Chemical Cystitis - Inflammation of the bladder due to radiation or chemical exposure.
  • Refractory Interstitial Cystitis - A chronic condition causing bladder pain and frequent urination that does not respond to standard treatments.
  • Hemorrhagic Cystitis - Bleeding in the bladder.
  • Neurogenic Bladder Disease - A condition affecting bladder control due to nerve damage.
  • Severe Incontinence - Significant loss of bladder control.
  • Trauma - Injury to the bladder.
  • Fistula - An abnormal connection between the bladder and other structures.
  • Upper Urinary Tract Obstruction - Blockage in the upper urinary tract affecting bladder function.
  • Refractory Urethral Stricture - A narrowing of the urethra that does not respond to treatment.

2. Procedure

The procedure for complete cystectomy with bilateral pelvic lymphadenectomy involves several critical steps:

  • Step 1: Incision - A low midline or transverse suprapubic incision is made to access the bladder. This incision allows the surgeon to effectively expose the bladder and surrounding structures.
  • Step 2: Dissection of Fascia - The overlying fascia is carefully divided to enter the space of Retzius, which is the area between the bladder and the pubic bone, facilitating further access to the bladder.
  • Step 3: Pelvic Lymph Node Dissection - A pelvic lymph node dissection is performed as needed, which involves the removal of lymph nodes to assess for cancer spread. Fatty tissue is stripped from the mid-portion of the common iliac vessels bilaterally and from the internal and external iliac vessels up to the circumflex iliac vein.
  • Step 4: Node Excision - The iliac, hypogastric, and obturator nodes are excised bilaterally to ensure comprehensive removal of potentially affected lymphatic tissue.
  • Step 5: Separation of Peritoneum - Blunt and sharp dissection techniques are employed to separate the parietal peritoneum from the dome and posterior wall of the bladder, allowing for the bladder to be freed from surrounding structures.
  • Step 6: Clamping and Dividing Pedicles - The superior bladder (vesical) pedicles are clamped and divided, which involves cutting the blood vessels supplying the bladder to facilitate its removal.
  • Step 7: Ureter Dissection - Any remaining portions of the distal ureters are freed from surrounding structures, ensuring that the entire bladder can be removed without complications.
  • Step 8: Complete Dissection - The dissection of the posterior bladder, bladder neck, and base of the bladder continues until the entire bladder is completely freed from all surrounding structures.
  • Step 9: Ligation of Vascular Pedicles - The lateral vascular pedicles are ligated and divided to prevent bleeding during the removal of the bladder.
  • Step 10: Removal of the Bladder - Finally, the urethra is divided, and the bladder is completely removed from the body.

3. Post-Procedure

Post-procedure care following a complete cystectomy with bilateral pelvic lymphadenectomy includes monitoring for complications such as bleeding, infection, and urinary leakage. Patients may require a catheter for urinary drainage during the initial recovery period. The expected recovery time can vary based on individual health factors and the extent of the surgery, but patients typically stay in the hospital for several days. Follow-up appointments are essential to monitor healing and manage any long-term effects of the surgery, including potential changes in urinary function and the need for urinary diversion if the bladder has been removed.

Short Descr REMOVAL OF BLADDER & NODES
Medium Descr CYSTECTOMY W/BI PELVIC LYMPHADENECTOMY
Long Descr Cystectomy, complete; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes
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) 2 - 150% payment adjustment 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).
52 Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient 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).
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
GC This service has been performed in part by a resident under the direction of a teaching physician
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Pre-1990 Added Code added.
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