2025 CPT code 45805
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures Digestive System Feed
Closure of rectovesical fistula with colostomy.
Modifiers may apply based on the circumstances of the procedure, e.g., 58 (staged procedure), 59 (distinct procedure), 78 (unplanned return to OR).
Medical necessity is established by the presence of a symptomatic rectovesical fistula, confirmed by imaging and/or clinical findings, where conservative management has failed or is inappropriate.The colostomy is medically necessary to protect the repair and allow healing.
The surgeon is responsible for the pre-operative planning, surgical procedure (including incision, dissection, fistula closure, colostomy creation), post-operative care, and follow-up. Anesthesiologists, nurses, and other support staff also contribute to the care.
In simple words: The doctor makes a cut in the belly to fix an abnormal connection between the rectum and bladder.They also create a colostomy (an opening in the belly for waste to pass through) to help the repair heal properly.
This procedure involves a surgical incision in the abdomen to repair an abnormal opening (rectovesical fistula) between the rectum and urinary bladder.The surgeon mobilizes the rectum and colon, dissects and closes the fistula, and then creates a colostomy using the sigmoid colon to allow the fistula closure to heal.The colostomy involves bringing a portion of the sigmoid colon to the abdominal surface, creating an opening for waste elimination.
Example 1: A 60-year-old male presents with recurrent urinary tract infections and fecaluria.A CT scan reveals a rectovesical fistula.The surgeon performs a 45805 procedure to close the fistula and create a temporary colostomy., A 45-year-old female with a history of diverticulitis develops a rectovesical fistula after a bowel perforation.Surgical repair (45805) is performed, with the colostomy intended to be reversed at a later date., A 72-year-old male presents post-radiation therapy for rectal cancer with a complex rectovesical fistula.The surgeon elects to proceed with a 45805 procedure given the high risk of recurrence without a protective colostomy.
Pre-operative diagnosis confirming rectovesical fistula; operative report detailing the surgical steps including closure of fistula and creation of colostomy; post-operative notes documenting patient’s recovery; imaging studies (e.g., CT scan, MRI); pathology report (if applicable).
** The complexity of the rectovesical fistula and patient factors influence the surgical approach and may necessitate variations in the procedure, affecting the coding and billing process.Always ensure comprehensive documentation.
- Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
- RVU: Information not provided; requires consultation of current fee schedules and RVU databases.
- Global Days : Information not available in dataset.The global period would depend on payer-specific guidelines and may vary.
- Payment Status: Active
- Modifier TC rule: No information found in the dataset regarding TC modifier applicability.
- Fee Schedule : Historical fee schedule information is not included in the provided data; refer to CMS fee schedules and historical databases for this information.
- Specialties:Colorectal Surgery, Urology, General Surgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center