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Official Description

Cystectomy, complete, with ureteroileal conduit or sigmoid bladder, including intestine anastomosis; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 51595 refers to a complete cystectomy, which is the surgical removal of the bladder, performed in conjunction with the creation of a urinary diversion. This urinary diversion can be achieved through either a ureteroileal conduit or a sigmoid bladder, which involves the use of intestinal segments to redirect urine from the kidneys to an external stoma. The procedure also includes a bilateral pelvic lymphadenectomy, which involves the removal of lymph nodes located in the pelvic region, specifically targeting the external iliac, hypogastric, and obturator nodes. The approach is intraperitoneal, meaning that the surgery is conducted within the peritoneal cavity, and it requires careful dissection and mobilization of various structures to ensure the successful removal of the bladder and the construction of the urinary diversion. The detailed steps of the procedure involve incisions, dissection of lymphatic tissues, isolation of bowel segments, and the creation of a stoma for urine expulsion, all of which are critical for the patient's postoperative recovery and management.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The procedure described by CPT® Code 51595 is indicated for patients requiring a complete cystectomy due to various conditions affecting the bladder. These may include:

  • Bladder Cancer - The most common indication for a complete cystectomy, where malignant tumors necessitate the removal of the bladder 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.
  • Bladder Trauma - Cases of severe injury to the bladder that cannot be repaired effectively, requiring its removal.
  • Congenital Anomalies - Certain congenital defects of the bladder that may warrant surgical intervention.

2. Procedure

The procedure involves several critical steps to ensure the successful removal of the bladder and the creation of a urinary diversion:

  • Step 1: Incision and Lymph Node Dissection - The surgery begins with a midline incision in the abdomen. Before the peritoneum is opened, the pelvic lymph nodes are dissected as necessary. This involves stripping fatty tissue from the common iliac vessels bilaterally and from the internal and external iliac vessels up to the circumflex iliac vein, followed by the excision of the iliac, hypogastric, and obturator nodes.
  • Step 2: Opening the Peritoneum - Once the lymph nodes are addressed, the peritoneum is opened, allowing access to the abdominal cavity. The small bowel is then isolated and packed away from the surgical field to prevent contamination.
  • Step 3: Ureteral Mobilization - The ureters are exposed and mobilized carefully to preserve surrounding perirenal tissue and blood supply. They are then divided as close to the ureterovesical junction as possible.
  • Step 4: Bowel Segment Isolation - Depending on whether a ureteroileal conduit or sigmoid bladder is to be constructed, a segment of either the ileum or sigmoid colon is isolated. The remaining bowel segments are then anastomosed to restore bowel continuity.
  • Step 5: Stoma Creation - A separate incision is made for the stoma, through which urine will be expelled. The anterior rectus fascia is incised, and the rectus muscle is divided using blunt dissection. If an ileal conduit is created, the distal end is pulled through the abdominal wall, everted, and sutured to the skin or subcutaneous tissue. The proximal end is closed with sutures.
  • Step 6: Ureteral Anastomosis - A tunnel is created from the conduit to the ureters, which are then pulled through the tunnel. The ends of the ureters are spatulated, and stents are placed in both ureters. Small incisions are made in the conduit for the ureters to be anastomosed approximately 3 cm apart.
  • Step 7: Sigmoid Bladder Construction - If a sigmoid bladder is constructed, a similar tunneling process is followed, with the ureters anastomosed to the sigmoid bladder. The sigmoid bladder is then exteriorized through the stomal incision, everted, and sutured to the skin or subcutaneous tissue, creating a colostomy.
  • Step 8: Bladder Removal - Following the urinary diversion, the bladder is mobilized using blunt and sharp dissection. The superior bladder pedicles are clamped and divided, and any remaining portions of the distal ureters are freed. The dissection continues until the bladder is completely detached from surrounding structures, followed by ligation and division of the lateral vascular pedicles and division of the urethra.
  • Step 9: Closure - Drains are placed as necessary, and the surgical incisions are closed in layers to ensure proper healing.

3. Post-Procedure

After the completion of the procedure, patients will require careful monitoring and management. Post-operative care includes monitoring for any signs of complications such as infection, bleeding, or issues with the stoma. Patients may need to be educated on stoma care and management of the urinary diversion. Recovery time can vary, and follow-up appointments will be necessary to assess healing and function of the urinary diversion. Additionally, drains may be in place to facilitate fluid management, and patients should be advised on activity restrictions during the initial recovery phase.

Short Descr REMOVE BLADDER/REVISE TRACT
Medium Descr CSTC COMPL W/CONDUIT/SIGMOID BLDR PEL LMPHADEC
Long Descr Cystectomy, complete, with ureteroileal conduit or sigmoid bladder, including intestine anastomosis; 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
GC This service has been performed in part by a resident under the direction of a teaching physician
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.
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).
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
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).
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.
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).
AQ Physician providing a service in an unlisted health professional shortage area (hpsa)
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
CR Catastrophe/disaster related
GW Service not related to the hospice patient's terminal condition
Q1 Routine clinical service provided in a clinical research study that is in an approved clinical research study
Q6 Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area
RT Right side (used to identify procedures performed on the right side of the body)
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
Date
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Notes
2002-01-01 Changed Code description changed.
Pre-1990 Added Code added.
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