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CPT®
45825

CPT® Code 45825

Official Description

Closure of rectourethral fistula; with colostomy

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

A rectourethral fistula is defined as an abnormal connection between the rectum and the urethra, which can lead to significant clinical complications. This condition may arise due to various factors, including postoperative complications, chronic infections, inflammation of the bowel, malignant tumors, or trauma. The presence of a rectourethral fistula can result in symptoms such as fecal incontinence, urinary incontinence, and recurrent urinary tract infections, which can severely impact a patient's quality of life. The surgical procedure coded as CPT® 45825 involves the closure of this type of fistula and is performed in conjunction with the creation of a colostomy. The colostomy serves as a temporary measure to divert stool away from the rectum, allowing for proper healing of the surgical site. Different surgical approaches may be utilized, including abdominal, perineal, and trans-sphincteric techniques, depending on the specific anatomy and condition of the patient. Prior to the closure procedure, a suprapubic cystostomy may be performed to divert urine, ensuring that the urethra is not compromised during the surgical intervention. The complexity of this procedure necessitates careful planning and execution to achieve optimal outcomes for the patient.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The closure of a rectourethral fistula with colostomy is indicated in the following situations:

  • Postoperative Complications: The procedure may be necessary when a rectourethral fistula develops as a complication following surgical interventions in the pelvic region.
  • Chronic Infection: Patients with chronic infections that lead to the formation of a fistula between the rectum and urethra may require this surgical intervention.
  • Inflammation of Bowel: Inflammatory conditions affecting the bowel can result in the development of a rectourethral fistula, necessitating closure.
  • Malignant Neoplasm: The presence of malignant tumors in the pelvic area can contribute to the formation of a rectourethral fistula, which may require surgical closure.
  • Trauma: Traumatic injuries to the pelvic region that result in a rectourethral fistula may also indicate the need for this procedure.

2. Procedure

The procedure for the closure of a rectourethral fistula with colostomy involves several detailed steps:

  • Step 1: Prior to the surgical intervention, a suprapubic cystostomy may be performed to divert urine from the urethra, ensuring that the urethra remains free from urine during the procedure. Alternatively, a catheter may be placed in the urethra to facilitate urine drainage.
  • Step 2: The surgeon may choose a trans-sphincteric approach, which begins with making a curvilinear incision between the coccyx and the posterior margin of the anus. This incision allows access to the internal sphincter mechanism and the posterior rectal wall.
  • Step 3: The internal sphincter mechanism and posterior rectal wall are carefully divided to expose the fistula. An incision is then made around the fistula, which is extended to the opening in the urethra to ensure complete access.
  • Step 4: The rectal wall is undermined and mobilized to facilitate closure. The opening in the urethra is then closed to prevent any further communication between the rectum and urethra.
  • Step 5: Rectal wall flaps are created and sutured over the opening in the rectum to ensure proper closure and healing of the rectal tissue.
  • Step 6: The incision in the posterior rectal wall is closed, and the internal sphincter is reapproximated to restore normal function.
  • Step 7: A colostomy is performed to temporarily divert stool from the rectum, which may involve mobilizing a segment of the sigmoid colon or other colon segment to the abdominal wall. A separate incision may be made for the stoma.
  • Step 8: If a loop colostomy is created, the loop is brought out of the abdominal wall at the stoma site, incised longitudinally, and the edges are folded back to expose the mucosa, which is then sutured to the abdomen, resulting in two stomas: one for stool elimination and another, known as a mucous fistula, for mucus elimination.

3. Post-Procedure

After the closure of the rectourethral fistula with colostomy, patients will require careful monitoring and post-operative care. The colostomy will need to be managed, and patients will receive instructions on how to care for the stoma. Recovery may involve a period of adjustment as the body heals and adapts to the colostomy. Follow-up appointments will be necessary to assess the healing of the surgical site and to ensure that there are no complications, such as infection or recurrence of the fistula. Patients may also need support and education regarding lifestyle changes and dietary modifications to accommodate the colostomy.
Short Descr REPAIR FISTULA W/COLOSTOMY
Medium Descr CLOSURE RECTOURETHRAL FISTULA W/COLOSTOMY
Long Descr Closure of rectourethral 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).
95 Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system.
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