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Urology Coding Alert

You Be the Coder:

Multiple Procedures via a Cystostomy

Published on Tue Jan 03, 2006

Question: My urologist treated a patient who did not have a urethra or part of her bladder neck due to prolonged catheter use and necrosis. He performed a cystotomy, removed bladder calculi, did a bladder neck closure, and placed a suprapubic tube. What should I bill for?


Illinois Subscriber


Answer: First, report CPT 51800 (Cystoplasty or cystourethroplasty, plastic operation on bladder and/or vesical neck [anterior Y-plasty, vesical fundus resection], any procedure, with or without wedge resection of posterior vesical neck) for the cystourethroplasty closure of the bladder neck. Next, submit CPT 51050 (Cystolithotomy, cystostomy with removal of calculus, without vesical neck resection) for the cystolithotomy and removal of the bladder stone.

Note: When you report more than one procedure, Medicare will automatically append modifier 51 (Multiple procedures) to all subsequent multiple procedures that are not bundled. This means you don't have to attach modifier 51 to the procedure codes for Medicare patients. For other insurance carriers, however, you should attach modifier 51 when you are reporting more than one procedure.

You should also report 51040 (Cystostomy, cystotomy with drainage) for the placement of the suprapubic cystostomy tube. Some urologists may consider this code an integral part of 51050, but 51040 and 51050 are not bundled. Often, after an open cystotomy, the urologist performs a primary closure of the bladder with Foley catheter urethral drainage and no suprapubic cystostomy tube.

For some urologists, a suprapubic tube is optional in this procedure and therefore not always an integral part of a suprapubic operation. You can consider it a separate procedure and thus a chargeable service. But some carriers may bundle codes 51040 and 51050, and they will often only reimburse for the 51050 including the placement of the suprapubic tube.

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