CPT® Code 51820

Official Description

Cystourethroplasty with unilateral or bilateral ureteroneocystostomy

Common Language Description

Cystourethroplasty with unilateral or bilateral ureteroneocystostomy, as described by CPT® Code 51820, refers to a surgical procedure aimed at reconstructing the bladder and its associated structures. This procedure is particularly relevant for patients who have experienced congenital anomalies, scarring, or deformities resulting from previous surgeries or traumatic injuries. The term 'cystourethroplasty' indicates that the surgery involves plastic reconstruction of the bladder, which may also extend to the vesical neck and urethra. The choice of reconstruction technique is tailored to the specific condition being treated, ensuring that the surgical approach is appropriate for the patient's unique anatomical and pathological circumstances. To access the bladder, a surgical incision is typically made, which can be either a low midline or a transverse suprapubic incision. The approach to the bladder defect varies depending on its location; defects in the posterior bladder are generally approached intraperitoneally, while those in the dome, anterior bladder, vesical neck, and urethra are approached extraperitoneally. During the procedure, the bladder is incised to allow for inspection of the defect, and if necessary, portions of the bladder, bladder neck, or urethra may be excised. The reconstruction process may involve reconfiguring the bladder wall, such as plicating the bladder neck or performing a Y-plasty to address an enlarged bladder trigone. In the context of CPT® Code 51820, the procedure specifically addresses defects located near one or both ureteral orifices, necessitating a ureteroneocystostomy in conjunction with the cystourethroplasty. This involves ligating and transecting one or both ureters at the ureterovesical junction, followed by the repair of the bladder defect and the transplantation of the ureters to a new site within the bladder. The surgical technique includes creating a trough in the muscular wall of the bladder where the ureter(s) will be placed, followed by securing the ureter(s) to the bladder's interior with sutures and closing the trough over the proximal aspect of the ureter(s). This comprehensive approach aims to restore normal bladder function and anatomy, addressing the underlying issues that prompted the need for surgical intervention.

1. Indications

The procedure described by CPT® Code 51820 is indicated for various conditions that necessitate surgical intervention on the bladder and ureters. The following are the explicitly provided indications for performing cystourethroplasty with unilateral or bilateral ureteroneocystostomy:

Congenital Anomalies - Conditions present at birth that affect the structure and function of the bladder and ureters.
Scarring - Tissue scarring that may result from previous surgeries or injuries, leading to functional impairment of the bladder.
Acquired Deformities - Abnormalities that develop over time due to surgical interventions or other medical conditions affecting the bladder and urethra.
Traumatic Injuries - Damage to the bladder or ureters resulting from physical trauma, necessitating reconstruction to restore normal function.

2. Procedure

The procedure for cystourethroplasty with unilateral or bilateral ureteroneocystostomy involves several critical steps, each designed to address the specific defects in the bladder and ureters. The following outlines the procedural steps as described:

Step 1: Incision - A low midline or transverse suprapubic incision is made to expose the bladder. This incision allows the surgeon access to the bladder and surrounding structures for the reconstruction process.
Step 2: Inspection of the Bladder - The bladder is incised to inspect the defect. This step is crucial for assessing the extent of the damage and determining the appropriate reconstruction techniques needed.
Step 3: Excision of Affected Tissue - Portions of the bladder, bladder neck, or urethra may be excised if necessary. This excision is performed to remove any damaged or non-functional tissue that could impede the success of the reconstruction.
Step 4: Bladder Wall Reconfiguration - The bladder wall is reconfigured as needed. Techniques such as plicating the bladder neck or performing a Y-plasty may be employed to address specific anatomical issues, such as an enlarged bladder trigone.
Step 5: Ureteroneocystostomy - If the bladder defect is located near one or both ureteral orifices, a ureteroneocystostomy is performed. This involves ligating and transecting one or both ureters at the ureterovesical junction.
Step 6: Repair of the Bladder Defect - After the ureters are transected, the bladder defect is repaired. This step is essential for restoring the integrity of the bladder.
Step 7: Creation of a Trough - An incision is made in the muscular wall of the bladder to create a trough where the ureter(s) will be placed. This trough is critical for the proper placement and securing of the ureters.
Step 8: Placement and Securing of Ureter(s) - The ureter(s) is placed in the trough within the detrusor muscle, and an incision is made in the bladder mucosa at the distal aspect of the trough. The ureter(s) is then secured to the interior aspect of the bladder with sutures.
Step 9: Closure of the Trough - Finally, the trough is closed over the proximal aspect of the ureter(s), completing the reconstruction and ensuring that the ureters are properly positioned within the bladder.

3. Post-Procedure

Post-procedure care following cystourethroplasty with unilateral or bilateral ureteroneocystostomy typically involves monitoring for complications and ensuring proper recovery. Patients may require a period of hospitalization for observation and management of any immediate postoperative issues. Pain management, hydration, and monitoring of urinary output are essential components of post-operative care. Follow-up appointments will be necessary to assess the healing process and the functionality of the bladder and ureters. Additional imaging or diagnostic tests may be performed to ensure that the reconstruction has been successful and that there are no complications such as leaks or obstructions. Patients should be educated on signs of potential complications, such as fever, increased pain, or changes in urinary habits, and instructed to report these to their healthcare provider promptly.

Short Descr	REVISION OF URINARY TRACT
Medium Descr	CSTOURTP W/UNI/BI URTRONEOCSTOST
Long Descr	Cystourethroplasty with unilateral or bilateral ureteroneocystostomy
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

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).

Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).