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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 result of surgical procedures, chronic infections, or inflammation affecting the pelvic structures. The closure of a rectovesical fistula with colostomy, as described by CPT® Code 45805, involves a surgical intervention where the abdomen is accessed to locate the fistula. During the procedure, any adhesions that may exist between the rectum and bladder are carefully lysed to separate these two structures. The surgeon then identifies the opening in the bladder and repairs it using sutures, ensuring that the integrity of the bladder is restored. Following this, the rectum is inspected, and if necessary, it is also closed with sutures. To further reduce the risk of recurrence of the fistula, omentum may be interposed between the bladder and rectum. Additionally, a colostomy is performed to divert stool away from the rectum temporarily, which can be crucial for the healing process. The colostomy is typically created in the sigmoid colon, and various techniques may be employed, including loop colostomy, loop with distal closure, or an end colostomy with a mucous fistula. After the completion of the procedure, drains may be placed in the abdomen as needed, and the abdominal incision is subsequently closed. This comprehensive approach aims to effectively manage the rectovesical fistula while ensuring patient safety and promoting recovery.
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The closure of a rectovesical fistula with colostomy, as indicated by CPT® Code 45805, is performed under specific circumstances. The following conditions may warrant this surgical intervention:
The procedure for the closure of a rectovesical fistula with colostomy involves several critical steps, each aimed at effectively addressing the fistula and ensuring patient safety:
Post-procedure care following the closure of a rectovesical fistula with colostomy is essential for ensuring proper recovery. Patients are typically monitored for any signs of complications, such as infection or leakage from the surgical sites. Pain management is provided as needed, and the surgical team will assess the function of the colostomy to ensure it is functioning correctly. Patients may require education on colostomy care and management to facilitate their recovery and adaptation to the new colostomy. Follow-up appointments are crucial to evaluate the healing process and address any concerns that may arise during recovery.
| Short Descr | REPAIR FISTULA W/COLOSTOMY | Medium Descr | CLSR RECTOVESICAL FISTULA W/COLOSTOMY | Long Descr | Closure of rectovesical fistula; with colostomy | 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 | 72 - Colostomy, temporary and permanent |
| 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). | 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.) | 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 |
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| Pre-1990 | Added | Code added. |
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