# fulguration of urethrovesical fistula



## nc_coder (May 12, 2015)

I am desperately looking for a cpt code.

The cystoscope was introduced.  The bladder was filled.  Suture line from prior psoas hitch was noted.  Small area of sinus tract was identified.  The entire line was burned using Bugbee elecrocautery.  Drained the bladder and placed a Foley.

Need a cpt code for Fulguration of urinary fistula using cystoscope. 

Thanks for any help you can give.


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## emcee101 (May 13, 2015)

NC - that's a really interesting case and I am trying to wrap my head around a urethrovesical fistula which, from an anatomic standpoint, does not make sense to me since they are connected structures to begin with. I see you mentioned a psoas hitch so I am assuming that the patient had a previous partial ureterectomy with ureteroneocystotomy but I don't see how this would affect the anatomy of the urethra. 

Just to confirm - this is a *urethro*vesical fistula and not a *ureter*ovesical fistula? 

If you can post the whole op note as well it might provide some context that could help. Thanks


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## nc_coder (May 13, 2015)

That was my issue.  I couldn't figure out how this was possible.  The dictation says "urethrovesical" in one part.  And unfortunately, what I posted earlier is pretty much the entire op note.  Here is a little bit of additional info:

Patient has a persistent urinary fistula for several months after psoas hitch following resection of her rectal cancer with invasion in to her bladder and ureter.  Because of this we elected to proceed with attempted ablation of the sinus tract with electocautery.  

The rest of the note is what I have already posted in my original thread.


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## emcee101 (May 14, 2015)

I'm pretty much at a loss other than to say that an unlisted code may be your only option. The only other code that might fit is 52214 but my experience tells me that (right or wrong...) this is not the intended purpose for this code. If you do consider using it, then I might check with your doctor to see if the locations listed in the code description relate anatomically to where they performed the fulgration.


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## nc_coder (May 14, 2015)

We were looking at that code too.  Thanks for your input.


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## JEYCPC (May 20, 2015)

Did the Doc confirm the urethrovesical fistula?  I've seen typos in my day especially lately.


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## BenCrocker (May 20, 2015)

Okay I was researching Psoas Hitch, and I learned that the surgery comes awfully close to the URETERS not the URETHRA. So QUERY the provider.


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## emcee101 (May 20, 2015)

I spoke to a urologist who I worked with for several years and mentioned this to him. He explained that since the bladder is pulled sharply to one side with the psoas hitch it can create a fold in the bladder neck which would then cause contact between the lower bladder wall and the proximal urethra. This contact could then cause a urethrovesical fistula which would need corection. Apparently it is somewhat common with patienst who have had a psoas hitch procedure. 

I still think it would fall under an unlisted code, and I would reference 52214 as a close description of the work performed.


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## JEYCPC (May 20, 2015)

emcee101 said:


> I still think it would fall under an unlisted code, and I would reference 52214 as a close description of the work performed.



I had a similar case recently with a vesicovaginal fistula.  It drove me to distraction.


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