A cystostomy is a surgical opening created from the urinary bladder to the exterior of the body, usually through the lower abdominal wall, for external urine drainage. This opening is maintained by a suprapubic catheter, providing an alternative drainage route when the urethral path is blocked. Closure is performed once the underlying condition has resolved, normal voiding function has returned, and external drainage is no longer needed. Accurate coding requires understanding the clinical work involved to ensure proper reimbursement.
Distinguishing Simple Removal from Formal Repair
The method used to code the cessation of a cystostomy tract depends entirely on the clinical effort required. In the simplest scenario, the physician removes the suprapubic catheter, allowing the small tract to close spontaneously, which is the expected outcome for an uncomplicated stoma. This simple removal is typically considered part of an Evaluation and Management (E/M) service and is not separately billable with a dedicated surgical code.
A slightly more involved, yet still minor, procedure is the simple exchange of a suprapubic catheter, reported using CPT code 51705. If the exchange is complicated by factors like infection, excessive granulation tissue, or a stricture requiring dilation, the more extensive code CPT 51710 is used. These codes describe an office-based procedure for changing the tube, not permanently closing the tract.
Formal surgical closure is warranted when the tract fails to close naturally or when the stoma is mature and large, requiring active surgical intervention to prevent leakage or a vesicocutaneous fistula. This procedure involves the surgeon making an incision, excising the epithelialized tract, and then closing the defect in the bladder wall and the abdominal layers with sutures. This closure is performed in an operating room setting, often under local or general anesthesia, and constitutes a reportable surgical service.
Selecting the Primary Procedure Code
For a planned, open surgical closure of a cystostomy, the standard CPT code is 51880, titled “Closure of cystostomy (separate procedure).” This code is used when the surgeon performs the layered closure of the bladder opening and the overlying abdominal wall defect. The designation “separate procedure” means it should not be coded when performed as a minor part of a larger, more comprehensive surgical procedure.
If the opening has developed into a vesicocutaneous fistula—a tract connecting the bladder to the skin that fails to heal—CPT 51880 is still the most appropriate code, as closing the fistula is fundamentally closing the failed cystostomy site. If the repair is exceptionally complex and involves significant reconstruction of the bladder wall beyond a simple suture closure, documentation may support a more extensive code, such as CPT 51800 for cystoplasty. The operative note must clearly describe the extent of the bladder wall repair to justify a more complex code.
When a minimally invasive approach (laparoscopic or robotic surgery) is used for cystostomy closure, no specific CPT code exists. The unlisted procedure code CPT 51999, which covers unlisted laparoscopic procedures on the bladder, must be utilized. When submitting CPT 51999, the practice must provide comprehensive documentation and benchmark the work to the closest open equivalent, CPT 51880, to establish reimbursement.
Modifiers and Contextual Billing Rules
A formal surgical closure coded with CPT 51880 is considered a major procedure and is subject to a 90-day global period, meaning routine post-operative care is bundled into the single payment. If the closure is performed as a staged procedure or a planned follow-up service during the global period of the initial cystostomy placement, Modifier 58 (Staged or related procedure) must be appended to CPT 51880. If the closure is performed as an unplanned return to the operating room for a related complication, Modifier 78 should be used instead.
For procedures that require significantly more effort, time, or technical difficulty than is typical, Modifier 22 (Increased Procedural Services) may be appended to CPT 51880. This is appropriate for closures complicated by severe scarring, significant infection, or unusual anatomy, but it requires extensive supporting documentation to justify the increased reimbursement. The documentation must clearly detail the extra work performed and the reason for the difficulty.
If cystostomy closure is performed concurrently with another distinct, unbundled procedure, a modifier is required to indicate that the two services are separate and independently billable. Modifier 59 (Distinct Procedural Service) is the general option, but payers prefer the more specific X[E, S, P, U] modifiers. For example, if the closure is on a separate anatomical site or structure, Modifier XS (Separate Structure) would be the more precise choice.