2025 CPT code 57307
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Female Genital System Surgery Feed
Closure of rectovaginal fistula; abdominal approach, with concomitant colostomy.
Modifiers may be applicable depending on the circumstances of the procedure.For example, modifier 58 (staged or related procedure) may be used if other related procedures are performed during the same operative session.Modifier 59 (distinct procedural service) might be used if the service is distinct from other procedures.
Medical necessity is established by symptoms consistent with a rectovaginal fistula (fecal incontinence, pelvic pain, recurrent infections), failure of conservative management, and the need for surgical intervention. Documentation should support the complexity of the fistula necessitating an abdominal approach and concomitant colostomy. The absence of infection and appropriate pre-operative optimization are also important.
The physician is responsible for patient positioning, anesthesia administration, incision and exploration of the abdominal cavity, bowel packing and mobilization, dissection of the rectovaginal fascia, fistula excision and closure, colostomy creation, drain placement, and abdominal closure.
In simple words: The doctor removes an abnormal connection between the rectum and vagina using an abdominal incision. Because the connection is large, they also create a temporary opening in the belly to divert bowel movements outside the body to help it heal.
This procedure involves the excision of a rectovaginal fistula through an abdominal approach.The surgeon makes a lower abdominal incision, enters the peritoneal cavity, and carefully dissects the vagina from the rectum to identify and excise the fistula. The defect is closed with sutures or staples. Due to the fistula's size, a colostomy is created to divert fecal matter externally. A loop of large bowel is brought out through a separate abdominal incision, and an opening is made to allow stool excretion. A drain may be placed for drainage into the vagina or externally.The abdominal incision is then closed.
Example 1: A 35-year-old woman presents with a large rectovaginal fistula following a difficult vaginal delivery.She experiences fecal incontinence and significant discomfort.An abdominal approach with concomitant colostomy is necessary due to the size and complexity of the fistula., A 40-year-old woman with Crohn's disease develops a rectovaginal fistula.Medical management fails, and surgery is indicated.The surgeon elects for an abdominal approach with a temporary diverting colostomy., A 50-year-old woman experiences recurrent rectovaginal fistula after previous repairs. Given the history of failure and complexity of the case, the surgeon decides an abdominal approach with concomitant colostomy is the best option.
Complete history and physical examination, documenting symptoms (fecal incontinence, pain, discharge), imaging studies (MRI, CT, or transvaginal ultrasound) to confirm diagnosis and size, operative report detailing the procedure performed, pathology report if tissue is sent for analysis, post-operative progress notes, and any complications.
** The choice of abdominal approach versus other approaches (vaginal, transperineal) is determined by the size, location, and complexity of the fistula.A concomitant colostomy is often temporary, but may be permanent in some cases. Careful documentation is crucial for accurate coding and reimbursement.
- Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
- Payment Status: Active
- Specialties:Colorectal Surgery, Gynecologic Surgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center