CPT Code for Neobladder Creation After Cystectomy
The CPT code that describes the creation of a neobladder after cystectomy, allowing the patient to void through the urethra, is 51596.
Understanding Urinary Diversion Options After Cystectomy
When performing a radical cystectomy for bladder cancer, several urinary diversion options exist:
- Ileal conduit: Simplest form of diversion
- Continent cutaneous diversion: Requires catheterization through abdominal stoma
- Orthotopic neobladder: Allows voiding through the urethra
Orthotopic Neobladder Characteristics
The orthotopic neobladder is specifically designed to:
- Allow patients to void through their native urethra
- Provide bladder function similar to a native bladder
- Create a reservoir from intestinal segments (typically ileum)
According to NCCN guidelines, an orthotopic neobladder "provides the closest bladder function to that of a native bladder albeit with an increased risk for nighttime incontinence as well as urinary retention requiring intermittent self-catheterization" 1.
CPT Code Selection Rationale
The correct code is 51596 because:
- It specifically describes "cystectomy with continent diversion"
- It includes creation of an "orthotopic neobladder"
- It specifies that the diversion allows voiding "through urethra"
Important Clinical Considerations
When planning for neobladder creation:
- Patient selection is critical: Relative contraindications to urethral drainage include Tis in the prostatic ducts or positive urethral margin 1
- Preoperative evaluation: In women undergoing orthotopic neobladder construction, obtain histological evaluation of the bladder neck and urethral margin 1
- Postoperative care: Patients should be monitored annually for vitamin B12 deficiency 1
- Continence outcomes: Daytime continence rates of approximately 90% and nighttime continence rates of 70-80% can be expected 2, 3
Potential Complications
- Urinary retention requiring intermittent catheterization
- Neobladder-vaginal fistula in female patients 4
- Ureterointestinal anastomotic strictures
- Metabolic acidosis
- Nighttime incontinence
Follow-up Recommendations
After cystectomy with neobladder creation, follow-up should include:
- Urine cytology
- Liver function tests
- Creatinine and electrolytes
- Chest radiograph
- Imaging of abdomen and pelvis every 3-6 months for 2 years, then as clinically indicated 1
In summary, CPT code 51596 is the appropriate code for cystectomy with creation of a neobladder that allows the patient to void through the urethra.