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A urethrovaginal fistula is a pathological connection between the urethra and the vagina, which can lead to significant complications such as urinary incontinence and recurrent urinary tract infections. This condition often arises as a result of surgical trauma during procedures like anterior vaginal repair or can occur due to obstetrical trauma during vaginal delivery. The closure of a urethrovaginal fistula, specifically with the use of a bulbocavernosus transplant, is a surgical procedure aimed at repairing this abnormal connection. The procedure involves not only the closure of the fistula but also the incorporation of a muscle flap from the bulbocavernosus muscle to enhance blood supply to the affected area, which may have suffered damage from prior surgical interventions or radiation therapy. This dual approach helps to ensure a more robust healing process and reduces the risk of recurrence of the fistula. The surgical technique requires careful dissection and mobilization of tissues to achieve a successful repair while minimizing complications and promoting optimal recovery for the patient.
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The closure of a urethrovaginal fistula with a bulbocavernosus transplant is indicated in the following situations:
The procedure for closing a urethrovaginal fistula with a bulbocavernosus transplant involves several detailed steps:
After the procedure, patients can expect a recovery period that may involve monitoring for any signs of complications such as infection or recurrence of the fistula. The placement of a suprapubic catheter allows for the urethra to heal without direct pressure or irritation from urine flow. Patients will be advised on care for the surgical site, including hygiene practices and activity restrictions to promote healing. Follow-up appointments will be necessary to assess the success of the repair and to remove the catheter once healing is confirmed.
| Short Descr | REPAIR URETHROVAGINAL LESION | Medium Descr | CLSR URETHROVAG FSTL W/BULBOCAVERNOSUS TRNSPL | Long Descr | Closure of urethrovaginal fistula; with bulbocavernosus transplant | 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 | 109 - Procedures on the urethra |
| 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). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient 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). | 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. | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code 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 | KX | Requirements specified in the medical policy have been met |
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| Pre-1990 | Added | Code added. |
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