There are three codes that you may use to repair the vesicovaginal communication or the fistula and that’s 51900 closure. It's an abdominal approach. You have a 57320 is a vaginal approach. And then you have a combination, the 57330 which is the transvesical and a transvaginal approach combined. Read this medical coding training article for more.
Remember that when you bill one of these three codes, you may also charge other services if you do those other services. If you cystoscopically fulgurate the fistulous tract as some urologists do, you would use the code 52214. If you put a cystostomy tube - formal cystostomy, bill the 51040.
If you do a percutaneous cystostomy, we spoke about the code 51102. If you're using an omental flap in your repair - and this is an add-on code, 49905. If you are using a Martius bulbocavernosus transplant in your repair, bill the code, 57311.
Now, the code 57311 is the repair of the urethrovaginal fistula. However, if all you're doing in the above coding and compliance case is using the Martius flap, add modifier -52 to indicate that you are not repairing a urethrovaginal fistula but you're using the Martius bulbocavernosus transplant.
If you're doing an injection procedure for putting contrast material into the bladder, you can bill the 51600. And if you interpret your cystogram and write up the interpretation, you can bill the 74430. Most of the time, this is done in the hospital so you would have to add modifier -26 for payment. And if you do an injection of the fistulous tract with contrast agent, use the code, 20501, and if you read the film, use 76080.
For instance, there is a repair of the urethrovaginal fistula. And you have two procedures. These are done transvaginal. 57310 is the closure of the fistula transvaginally and 57311 is transvaginal closure of the fistula using a Martius flap or the bulbocavernosus transplant.
Medical Coding and Billing Tip: Remember also that if you do this procedure and you do these other services, these other services are chargeable services so that you can bill these services in addition to the closure. You did a cystostomy 51040, percutaneous cystostomy 51102. You did an anterior repair, you can bill for the anterior repair or for a sling. If you do a retrograde urethrogram, you can bill the 51610 for doing the urethrogram and 74450 modifier -26 if you write up an interpretation of the urethrogram.
Let's look at a clinical scenario. We have closure of the vesicovaginal fistula using a transvesical and a vaginal approach with an abdominal omental flap and a Martius bulbocavernosus transplant. Well, since we’re using the combined approach, transvaginal and transvesical, we would use the code 57330 with the diagnosis 619.0, urinary genital track fistula in the female as per the medical coding rules.
We’re draining the bladder with a suprapubic cystostomy, which you can bill, 51040 with modifier -51. The diagnose is 788.37 continuous urinary leakage that the patient would have. And then you are using a Martius flap, 57311, with a -52 modifier. And we’re using an omental flap, the 49905 which is an add-on code. Note that you do not need to add the -51 modifier.
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