Important 2025 NCCI Guidelines Update: Cystectomy Procedures Now Include Total Urethrectomy
Important 2025 NCCI Guidelines Update: Cystectomy Procedures Now Include Total Urethrectomy
As of January 2025, the National Correct Coding Initiative (NCCI) has implemented a significant update affecting the reporting of cystectomy procedures when performed with total urethrectomy. This update impacts processing for practitioner and facility claims.
Key Changes to the 2025 NCCI Guidelines
The NCCI edits now consider total urethrectomy to be included in cystectomy procedures. This means that when both procedures are performed together, only the cystectomy code should be reported. This edit cannot be resolved even with a modifier.
One example would be the below:
β’ 51580 (Cystectomy, complete, with ureterosigmoidostomy/ureterocutaneous transplantations)
β’ 53210 (Urethrectomy, total, with cystostomy; female)
β’ Now, only 51580 would be the appropriate code to report
Cystectomy & Urethrectomy Procedure Overview
A cystectomy is a surgical procedure that involves the removal of the urinary bladder, while a urethrectomy involves the surgical removal of the urethra (the tube that carries urine from the bladder to outside the body). These procedures are often performed together in cases of extensive urological disease or cancer.
Impact on Coding Practice
Medical coders should:
- Review all cystectomy claims to ensure compliance with this new edit.
- Remove separate urethrectomy codes when billed with included cystectomy procedures.
Documentation Requirements
While the procedures are now bundled, providers should continue to document both procedures in detail when performed. This maintains clinical accuracy and supports the coded procedures.
This update reinforces the importance of staying current with NCCI guidelines and their impact on both professional and facility coding practices.
For additional information on the 2025 NCCI edits, review our webinar recording here.