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The CPT® Code 51585 refers to a complete cystectomy procedure that includes the surgical removal of the bladder along with the creation of a urinary diversion, specifically through ureterosigmoidostomy or ureterocutaneous transplantation. This procedure is typically indicated for patients with severe bladder conditions, such as cancer, that necessitate the complete removal of the bladder. The surgical approach is intraperitoneal, meaning that the operation is conducted within the peritoneal cavity, which houses the abdominal organs. The procedure begins with a midline incision in the abdomen, allowing access to the pelvic region. Prior to entering the peritoneum, the surgeon dissects the pelvic lymph nodes, which may be necessary for staging or treatment of malignancies. The procedure also involves the meticulous dissection of fatty tissue surrounding the common iliac vessels and the excision of lymph nodes in the iliac, hypogastric, and obturator regions bilaterally. Following the opening of the peritoneum, the small bowel is temporarily moved out of the surgical field to expose the ureters, which are then mobilized and divided at the ureterovesical junction. A segment of the sigmoid colon is prepared to create a new pathway for urine drainage, and the ureters are anastomosed to this segment. The procedure concludes with the removal of the bladder and the closure of surgical incisions, ensuring that all necessary structures are addressed for optimal patient recovery and function.
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The procedure described by CPT® Code 51585 is indicated for patients with conditions that require the complete removal of the bladder, often due to malignancies or severe bladder dysfunction. The following are specific indications for performing this procedure:
The procedure for CPT® Code 51585 involves several critical steps that ensure the successful removal of the bladder and the establishment of a urinary diversion. The following outlines the procedural steps:
After the completion of the procedure, patients typically require careful monitoring and management of their recovery. Post-operative care may include the management of drains, monitoring for signs of infection, and ensuring proper urinary function through the newly established diversion. Patients may experience a period of adjustment as they adapt to the changes in urinary function. Follow-up appointments are essential to assess healing, manage any complications, and provide education on the care of the urinary diversion, whether it is through the sigmoid colon or a stoma. Pain management and rehabilitation may also be part of the post-procedure care plan to support the patient's recovery.
| Short Descr | REMOVAL OF BLADDER & NODES | Medium Descr | CYSTECTOMY W/URETEROSIGMOID BI PELV LYMPH NODES | Long Descr | Cystectomy, complete, with ureterosigmoidostomy or ureterocutaneous transplantations; 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. | 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. | 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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