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A rectovesical fistula is defined as an abnormal connection between the rectum and the urinary bladder, which can lead to significant clinical complications. This condition may arise as a postoperative complication or as a result of chronic infections or inflammation affecting the pelvic structures. The procedure coded as CPT® 45800 involves the surgical closure of this type of fistula. During the operation, the abdomen is surgically opened to access the affected area, where the fistula is identified. The surgeon carefully lyses any adhesions that may exist between the rectum and the bladder, allowing for the separation of these two structures. Following this, the opening in the bladder is located and meticulously repaired using sutures to ensure a proper seal. The rectum is also inspected, and if necessary, it is closed with sutures to restore its integrity. To further reduce the risk of recurrence of the fistula, omentum—a fold of peritoneum—may be interposed between the bladder and rectum. In some cases, a colostomy may be performed to temporarily divert stool away from the rectum, with the procedure typically involving the sigmoid colon. Various types of colostomies can be created, including loop colostomy, loop with distal closure, or an end colostomy with a mucous fistula. Additionally, drains may be placed in the abdominal cavity as needed, and the abdominal incision is subsequently closed. It is important to note that CPT® 45800 is specifically used for the closure of a rectovesical fistula without the performance of a colostomy, while CPT® 45805 is designated for cases where a colostomy is included in the procedure.
© Copyright 2025 Coding Ahead. All rights reserved.
The closure of a rectovesical fistula is indicated in cases where there is an abnormal communication between the rectum and urinary bladder, which can lead to complications such as urinary incontinence, fecaluria, or recurrent urinary tract infections. The procedure is typically performed when the fistula is symptomatic or when conservative management has failed. Specific indications for this surgical intervention may include:
The procedure for the closure of a rectovesical fistula involves several critical steps, which are outlined as follows:
Post-procedure care following the closure of a rectovesical fistula typically involves monitoring for any signs of complications, such as infection or leakage from the surgical site. Patients may require a period of hospitalization for observation and management of pain. If a colostomy was performed, the patient will receive education on colostomy care and management. Follow-up appointments are essential to assess healing and ensure that the fistula has been successfully closed. The healthcare team will provide guidance on dietary modifications and activity restrictions during the recovery period to promote optimal healing.
| Short Descr | REPAIR RECT/BLADDER FISTULA | Medium Descr | CLOSURE RECTOVESICAL FISTULA | Long Descr | Closure of rectovesical fistula; | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 96 - Other OR lower GI therapeutic procedures |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2010-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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