Ensure Spot-on Medical Coding for Fistula Repairs


We have three closures that are three CPT codes for closure of a vesicovaginal fistula. One code is 51900 and this is closure using an abdominal approach, 57320 closure using a vaginal approach and 57330 a transvesical, transvaginal. That would be a vaginal and abdominal approach. Read this article and get expert coding and compliance tips and strategies for accurately reporting fistula repairs.

Now we want to also point out tissue that is used for inter-position and these are other procedures that you may add to the above procedures to secure or ensure complete closure, such as peritoneal free or pedicle flap 20926, a Singapore flap which is a growing skin subcutaneous pedicle flap coded 14040, and omental flap 49905 which is an add-on code, and a Marshall's bulbocavernosus transplant, which is 57311 modifier -52.

And then for repairs of rather severe fistulas and repeat repairs, many physicians are using the gracilis muscle flap. And that's reported with 15734. Notice that the relative value units for that code is rather high 34.41, in 2010 39.83. So they are much higher than the above three closures. So, as per the medical coding guidelines, when you bill this for a gracilis muscle flap, this code is billed first as your primary code, the 15734, and then the closure codes above as secondary procedures.

There are some other chargeable services that may be billed along with those three vesicovaginal fistula closure codes.

You may also bill and be paid for a suprapubic cystostomy, 51040. If you choose to do a percutaneous if you're doing a vaginal approach, you can bill the code 51102. Now, if it is your style to do a cystogram to check the closure after the procedure, you may also bill for the injection of the contrast material for the cystogram, 51600. And if you read the cystogram yourself and report it in the operative report under a heading of radiological findings, you can also bill for the interpretation of the cystogram using code 74430, modifier -26 as most of these will be done in the hospital.

There is a repair that many physicians are using. It's an old repair for the vesicovaginal fistula. And it is basically a transvaginal repair but also a partial colpocleisis obliterating the upper vagina surrounding the fistula.

Now, in the CPT medical coding for this, you would use your vaginal approach, the 57320, and the procedure for a colpocleisis, which is 57120. You would add modifier -52 because you are only obliterating the upper portion of the vagina surrounding the fistula. So modifier -52 would indicate a reduced service.

Suppose we have a vesicovaginal tract that we are going to repair laparoscopically. And we’re doing a laparoscopic robotic existed closure of the vesicovaginal fistula. Because we do not have a laparoscopic procedure or laparoscopic CPT code for that procedure, it is suggested that you use the code 51999, an unlisted laparoscopic procedure for the bladder. And for non-Medicare carriers, non-Medicare, it is suggested if you use robotic technology to use the code S2900 the use of robotic technology.

Now remember, when using an unlisted code, you must send a very detailed operative report and covering letter benchmarking CPT code 51900, abdominal repair of the fistula as a procedure similar in technique, time of the procedure and skill required to do the procedure. And send these letters to ensure a proper payment for the laparoscopic procedure and repair.

Now, what about the closures of a urethral-vaginal fistula, same diagnosis? And there are two codes for the closure of this type of tract. Use the code 57310 for closure transvaginal, relative value units 12.95 and 57311 for closure with a Martius flap, bulbocavernosus transplant.

Medical Billing and Coding Training Tip: If you are going to use a Martius flap, but you're not repairing urethral-vaginal fistula, then you would bill the code 57311 with modifier -52 as we had on the previous page to indicate that you just did the Martius flap and not the closure of the urethral-vaginal fistula. And that has a relative value unit of 14.79.

Now, other chargeable services may include and you will be paid if you also bill this is a suprapubic cystostomy, percutaneous cystostomy. If you do an anterior repair or sling at the same time you're doing your urethral-vaginal fistula repair, notice that these two latter codes have higher relative value units than the closure codes so that these codes would be your primary procedure. And your closure of the urethral-vaginal fistula would be your secondary procedures.

If you also like to do radiological studies as the closure to ensure that the closure has been complete and you do an injection retrograde urethrogram, you can also bill the 51610. And if you read the injection retrograde urethrogram and put it and document it in the medical records, you can also bill 74450, modifier -26 because it's being done in the hospital. You don't own the radiological equipment. And you're just doing the interpretation of the films.

Keep yourself updated with the recent medical coding guidelines and rules; visit our medical coding conference page.

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