Summary & Overview
CPT 51065: Bladder Incision and Ureteral Stone Removal
CPT code 51065 denotes an open bladder incision to remove a ureteral calculus, often employing a calculus basket and fragmentation methods (ultrasonic or electrohydraulic). This procedure is an important component of urologic surgical care for stones that cannot be managed endoscopically or fragmented and passed with less invasive techniques. Nationally, the code captures resource use, hospital and ambulatory surgery billing, and inform coverage decisions for higher-complexity stone management.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for when CPT code 51065 is used, typical sites of service, common billing modifiers and payer considerations, and related coding guidance where available. The publication outlines benchmarks for utilization and payment patterns where data is available and summarizes policy and coverage drivers affecting access to surgical stone removal. Clinical context addresses the procedural steps implied by the code and typical care settings, helping coding and billing professionals, urology clinicians, and policy analysts understand implications for claims, documentation, and payer interactions.
Data not available in the input: associated taxonomies, ICD-10 diagnoses, related codes, specific service-line details.
Billing Code Overview
CPT code 51065 describes an open surgical procedure in which the provider makes an incision into the urinary bladder to remove a ureteral calculus (stone). The extraction may use manual devices such as a calculus basket and may include fragmentation techniques such as ultrasonic or electrohydraulic fragmentation of the ureteral calculus.
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Service type: Surgical removal of ureteral calculus via cystotomy with extraction and possible fragmentation
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Typical site of service: Operating room or ambulatory surgery center, with the procedure performed under appropriate anesthesia and sterile conditions
Clinical & Coding Specifications
Clinical Context
A 56-year-old male presents to the emergency department with acute right flank pain, gross hematuria, and nausea. Imaging (non-contrast CT abdomen/pelvis) demonstrates a 9 mm distal ureteral stone impacted at the ureterovesical junction with associated hydronephrosis and recurrent febrile urinary tract infections despite antibiotic therapy. After failed attempts at conservative management and ureteral stent placement, the urology team schedules an open transvesical ureterolithotomy.
In the operative workflow for 51065, the patient is brought to the operating room, placed under general anesthesia, and prepped in lithotomy or supine position. A lower abdominal incision is made to expose the bladder. A cystotomy is performed and the ureteral calculus is identified and removed using instruments such as a calculus basket and, if needed, ultrasonic or electrohydraulic lithotripsy to fragment the stone for extraction. Hemostasis is achieved, the bladder is closed, and a ureteral stent or bladder catheter may be left in place. The patient is monitored postoperatively for pain control, urine output, signs of infection, and renal function. Typical recovery includes short inpatient observation with removal of catheters or stents at follow-up as indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services |