Summary & Overview
CPT 51565: Bladder Resection with Ureteral Reimplantation
CPT code 51565 denotes a urologic reconstructive surgery in which a diseased or injured bladder segment adjacent to a ureter is removed and the ureter is reimplanted into the bladder at a new entry site. This procedure restores ureterovesical continuity and addresses conditions such as localized bladder injury, focal disease near the ureteral orifice, or complications from prior surgery. It is performed in appropriate surgical settings, typically in a hospital operating room or an ambulatory surgery center, by urologic surgeons.
Nationally, this code matters for surgical case mix, access to reconstructive urologic care, and payment policy for complex inpatient and outpatient urologic procedures. Key payers discussed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, and an outline of common billing modifiers used with this code. The publication presents benchmarking information, payer coverage considerations, and recent policy updates affecting reimbursement and documentation expectations. Clinical context explains indications and operative intent to help nonclinical stakeholders understand service complexity and resource implications. Data limitations: Data not available in the input where payer-specific rates, associated taxonomies, and ICD-10 mappings would normally be reported.
Billing Code Overview
CPT code 51565 describes a surgical procedure in which a diseased or injured portion of the bladder adjacent to a ureter is excised and the affected ureter is reimplanted into the bladder through a newly created vesical entry site. This operation is used to restore proper ureterovesical continuity and function after localized bladder or ureteral injury or disease.
Service type: Surgical — Urologic reconstructive procedure
Typical site of service: Hospital operating room or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A typical patient is a female in her 40s–70s presenting with recurrent urinary tract infections, vesicoureteral reflux, or a localized bladder lesion adjacent to a ureteral orifice causing obstruction or urine leakage. Preoperative evaluation includes history and physical, urinalysis and urine culture, renal ultrasound or CT urogram to assess upper tracts, cystoscopy to visualize the bladder and ureteral orifice, and possibly retrograde pyelography. The decision is made to excise the diseased bladder wall segment near the ureter and reimplant the ureter into a newly created bladder entry to restore normal urine flow and prevent reflux.
Perioperative workflow: the patient undergoes general anesthesia in an accredited ambulatory surgical center or hospital operating room. Prophylactic antibiotics are given per protocols. The urologist performs an open or limited open surgical approach to excise the affected bladder segment and create a new ureteral tunnel or orifice followed by ureteroneocystostomy (ureteral reimplantation) with or without a stent. Hemostasis is secured and the bladder is closed; a Foley catheter is typically left in place postoperatively. Postoperative care includes monitoring urine output, pain control, removal of drains/stents per protocol, and follow-up imaging (renal ultrasound or voiding cystourethrogram) as indicated to confirm repair integrity.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier — default | Use when no specialty or unusual circumstance modifier applies. |