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Official Description

Cystectomy, complete, with ureterosigmoidostomy or ureterocutaneous transplantations;

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 51580 involves a complete cystectomy, which is the surgical removal of the entire bladder. This procedure is typically indicated for patients with severe bladder conditions, such as cancer, that necessitate the complete removal of the bladder. Following the cystectomy, a urinary diversion is created, which can be achieved through either a ureterosigmoidostomy or ureterocutaneous transplantation. In a ureterosigmoidostomy, the ureters, which are the tubes that carry urine from the kidneys, are connected to the sigmoid colon, allowing urine to be expelled through the rectum. Alternatively, in a ureterocutaneous transplantation, the ureters are connected to the skin surface, creating a stoma through which urine is drained externally. The procedure is performed using an intraperitoneal approach, which involves making an incision in the midline of the abdomen and carefully dissecting surrounding tissues and lymph nodes to access the bladder and ureters. This complex surgical intervention requires meticulous attention to detail to preserve surrounding structures and ensure proper urinary function post-surgery.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The complete cystectomy with urinary diversion is indicated for various severe bladder conditions, including:

  • Bladder Cancer - The primary indication for this procedure is the presence of malignant tumors within the bladder that require complete removal to prevent the spread of cancer.
  • Severe Bladder Dysfunction - Conditions that lead to significant impairment of bladder function, which may not be manageable through less invasive treatments, can also necessitate this procedure.
  • Bladder Trauma - Significant injury to the bladder that cannot be repaired may require complete cystectomy as a solution.
  • Congenital Anomalies - Certain congenital defects affecting the bladder may warrant surgical intervention through cystectomy.

2. Procedure

The procedure for complete cystectomy with ureterosigmoidostomy or ureterocutaneous transplantation involves several detailed steps:

  • Step 1: Preparation and Incision - The patient is positioned, and the abdomen is prepared for surgery. A midline incision is made to access the abdominal cavity.
  • Step 2: Lymph Node Dissection - Prior to opening the peritoneum, pelvic lymph nodes are dissected as necessary to assess for any potential spread of disease.
  • Step 3: Vascular Preparation - Fatty tissue is carefully stripped from the mid-portion of the common iliac vessels bilaterally, as well as from the internal and external iliac vessels up to the circumflex iliac vein. This step is crucial for ensuring adequate blood supply during and after the procedure.
  • Step 4: Node Excision - Iliac, hypogastric, and obturator nodes are excised bilaterally to further evaluate the extent of any disease.
  • Step 5: Opening the Peritoneum - The peritoneum is opened to gain access to the bladder and surrounding structures.
  • Step 6: Isolation of the Small Bowel - The small bowel is isolated and packed out of the surgical field to provide a clear view of the surgical area.
  • Step 7: Ureter Mobilization - The ureters are exposed and mobilized, ensuring that perirenal tissue and blood supply are preserved. The ureters are then divided as close to the ureterovesical junction as possible.
  • Step 8: Sigmoid Colon Preparation - A segment of the sigmoid colon is selected and mobilized to create a pathway for the ureters.
  • Step 9: Ureter Connection - A tunnel is created from the sigmoid colon to the ureters, allowing the ureters to be pulled through and into the lumen of the sigmoid colon. The ends of the ureters are spatulated along the anterior aspect to facilitate anastomosis.
  • Step 10: Stenting - Stents are placed in both ureters to ensure proper drainage during the healing process.
  • Step 11: Anastomosis - The ureters are anastomosed to the sigmoid colon, and the stents are pulled through the colon, exiting through the anus. Alternatively, the ureters may be transplanted to the skin surface, creating a stoma.
  • Step 12: Bladder Mobilization - Following the urinary diversion, blunt and sharp dissection is used to mobilize the bladder. The superior bladder pedicles are clamped and divided, and any remaining portions of the distal ureters are freed from surrounding structures.
  • Step 13: Complete Removal - Dissection continues until the entire bladder is completely freed from all surrounding structures. The lateral vascular pedicles are ligated and divided, and the urethra is then divided to remove the bladder completely.
  • Step 14: Closure - Drains are placed as needed, and the surgical incisions are closed in layers to promote healing.

3. Post-Procedure

After the completion of the cystectomy and urinary diversion, patients typically require careful monitoring and management. Post-operative care may include pain management, monitoring for signs of infection, and ensuring proper function of the urinary diversion. Patients may need to adapt to changes in urinary function, especially if a stoma has been created. Follow-up appointments are essential to assess recovery and address any complications that may arise. Additionally, education on stoma care and lifestyle adjustments may be necessary for patients who undergo ureterocutaneous transplantation.

Short Descr REMOVE BLADDER/REVISE TRACT
Medium Descr CYSTECTOMY W/URETEROSIGMOIDOSTOMY W/NODES
Long Descr Cystectomy, complete, with ureterosigmoidostomy or ureterocutaneous transplantations;
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.
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.
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.
79 Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
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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2010-01-01 Changed Code description changed.
Pre-1990 Added Code added.
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