2025 CPT code 51597
(Active) Effective Date: N/A Revision Date: N/A Surgery - Urinary System Feed
Complete pelvic exenteration for vesical, prostatic, or urethral malignancy, including bladder removal and ureteral transplantations, with or without hysterectomy and/or abdominoperineal resection of the rectum and colon and colostomy.
Modifiers may apply in specific circumstances, such as increased procedural services (22), multiple procedures (51), or assistant surgeon (80/81/82).
Medical necessity is established by the presence of vesical, prostatic, or urethral malignancy requiring extensive surgical resection for optimal tumor control. Documentation should support the extent of the disease and the rationale for the procedure chosen.
The physician is responsible for the complete surgical management of the patient, including preoperative planning, intraoperative execution of the procedure, and postoperative care.
In simple words: This is a major surgery to remove cancerous organs in the pelvis. This may include the bladder, parts of the urinary system, and sometimes reproductive organs, parts of the colon and rectum.New openings are created on the abdomen for urine and stool to pass out of the body.
This procedure involves the en bloc resection of pelvic structures for vesical, prostatic, or urethral malignancy. It includes removal of the bladder, ureteral transplantations, and may also involve hysterectomy and/or abdominoperineal resection of the rectum, colon, and creation of a colostomy in various combinations.The procedure begins with a low midline abdominal incision.Blood vessels are clamped, and the bladder, urethra, lower ureters, and regional lymph nodes are removed. Depending on the extent of the malignancy, the reproductive organs (prostate in males, uterus and ovaries in females), rectum, and colon may also be resected. If both the rectum and bladder are removed, two stomas are created on the abdominal wall for the passage of urine and feces.The abdominal wound is then closed by suturing the tissue layers.
Example 1: A male patient with advanced prostate cancer involving the bladder and rectum undergoes complete pelvic exenteration with removal of the prostate, bladder, rectum, and formation of a colostomy and urinary diversions., A female patient with urethral cancer undergoes complete pelvic exenteration, which includes removal of the urethra, bladder, uterus, ovaries, and anterior vaginal wall. Ureteral transplantations are performed for urinary diversion., A male patient with bladder cancer extending to the prostate undergoes a complete pelvic exenteration with removal of the bladder, prostate, and urethra. The rectum and colon are spared.
Documentation should include operative report detailing the extent of the resection, organs removed, reconstruction performed, and any complications encountered. Preoperative diagnostic imaging, pathology reports confirming malignancy, and medical necessity justification are also required.
- Revenue Code: P1G - Major Procedure - Other
- Global Days: Global days are likely 90 as this is a major surgery, but always verify current payer guidelines.
- Specialties:Urology, Surgical Oncology, Gynecologic Oncology (if applicable)
- Place of Service:Inpatient Hospital