What is the code for creating a neobladder after a cystectomy, allowing the patient to void through their urethra (urinary diversion)?

CPT Code for Neobladder Creation After Cystectomy

The correct CPT code for cystectomy with creation of a neobladder that allows the patient to void through their urethra is 51596. 1

Understanding Urinary Diversion Options

Radical cystectomy for bladder cancer involves removal of the bladder, which necessitates creating an alternative method for urinary diversion. The main options include:

1. Ileal conduit (non-continent external diversion)
2. Continent cutaneous diversion (continent external diversion)
3. Orthotopic neobladder (internal diversion allowing voiding through urethra)

Neobladder Creation and Coding

The orthotopic neobladder procedure specifically:

• Creates a reservoir using intestinal segments (typically ileum)
• Connects this reservoir to the patient's native urethra
• Allows the patient to void through their natural urethral opening
• Provides the closest function to a native bladder 2

CPT code 51596 specifically describes "cystectomy with continent diversion" and includes creation of an "orthotopic neobladder" that allows voiding through the urethra 1.

Clinical Considerations for Neobladder Creation

When performing this procedure, several important clinical factors should be considered:

• Patient selection: Relative contraindications include Tis in the prostatic ducts or positive urethral margin 2, 1

• Surgical technique: The procedure involves:

  • Cystectomy (removal of bladder)
  • Creation of a reservoir using intestinal segments
  • Anastomosis to the patient's urethra

• Postoperative considerations:

  • Risk of nighttime incontinence
  • Potential need for intermittent self-catheterization due to urinary retention 2
  • Need for vitamin B12 monitoring 1

Coding Differentiation

The CPT codes in question represent different urinary diversion approaches:

• 51580: Cystectomy, complete, with ureteroileal conduit or sigmoid bladder
• 51590: Cystectomy, complete, with ureteroileal conduit or sigmoid bladder, with bilateral pelvic lymphadenectomy
• 51595: Cystectomy, complete, with ureteroileal conduit or sigmoid bladder, with bilateral pelvic lymphadenectomy and bilateral ureteral transplantation
• 51596: Cystectomy, complete, with continent diversion, any technique, using any segment of bowel

Only code 51596 specifically describes the creation of a continent diversion that allows voiding through the urethra (neobladder), making it the correct answer.