# Need help for Repair of Colovaginal and Colovesical Fistula



## hcg (Jan 27, 2016)

I'm trying to find a code for repair of colovaginal and colovesical fistula. But the codes would lead me to closure of rectovaginal fistula (57300 - 57308) and closure of rectovesical fistula (45800, 45805). Any suggestions? Every help is greatly appreciated.

Thank you.


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## syllingk (Jan 27, 2016)

you didn' t say how so look at 51900, 57320-57330, and 44660-44661


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## hcg (Jan 28, 2016)

*Op Report*



syllingk said:


> you didn' t say how so look at 51900, 57320-57330, and 44660-44661



Here's the detailed Op report:

Procedure: Robotic-assisted laparoscopic low anterior colon resection with take down and repair of colovaginal and colovesical fistula. Flexible sigmoidoscopy.

Pre-op & Post-op dx: Vaginal cuff abscess with colovaginal and colovesical fistula

Procedure Summary:
After obtaining informed consent the patient was taken to the operating and placed in supine low lithotomy position. Following the smooth induction of general endotracheal anesthesia and a surgical timeout flexible sigmoidoscopy was performed to 30 cm. No definitive evidence of rectovaginal or colovaginal fistula, perforation or mass was identified. The abdominen and perineum was then prepped and draped in standard sterile fashion and Hassan technique was utilized and the peritoneal cavity supraumbilically. Pneumoperitoneum was established to 15 mmHg and 28 mm robotic ports were placed in the right and left epigastrium followed by a 5 mm assist port in the right upper quadrant. The da Vinci surgical robot was docked and small bowel was delivered from the pelvis revealing distal sigmoid colon to be densely adherent to the bladder. Sharp dissection was carried out utilizing EndoShears revealing an obvious pocket of abscess that was completely drained evacuated. Further dissection between the anterior rectum and posterior bladder demonstrated an obvious that was completely drained and evacuated.  Further dissection between the anterior rectum and posterior bladder demonstrated an obvious communication with the super vaginal cuff. Continued dissection down in the pelvis allowed for transition to healthy tissue and inspection of the surgical field revealed a short segment of distal sigmoid colon that was obviously inflamed, thickened and had several areas of serosal injury following the dissection. The distal sigmoid was divided at the rectosigmoid junction utilizing and Ando GIA 60 mm purple reticulating tri-stapler.  The mesentery was taken sequentially with the robotic vessel sealer from distal to proximal. The sigmoid colon was mobilized laterally along the white line of Toldt and off the left pelvic sidewall sharply with EndoShears without difficulty.

At this stage, the vaginal cuff was oversewn in 2 layers utilizing a 20V lock PDS employing a running continuous suture followed by a 30V lock PDS second layer. The pelvis was irrigated copiously and suctioned out and vaginal cuff repair was thoroughly evaluated and found to be hemostatic and intact. The da Vinci surgical robot was undocked and the Hassan incision was extended down through the umbilicus and a medium Alexis wound protector was placed. The sigmoid colon was exteriorized and approximately 6 cm segment of the distal sigmoid colon was transected between atraumatic bowel clamps with curved Mayo scissors and passed off the field.  The anvil 28 EEA was placed into the end of the sigmoid colon and brought out through the side utilizing a tenia. The end of the colon was then sealed with an Endo GIA 60 mm reticulating purple tri-stapler. The colon was reintroduced into the peritoneal cavity and pneumoperitoneum was reestablished. A side to and stapled circular colorectal anastomosis was then performed with a 28 mm EEA without difficulty. Both proximal and sital donuts were inspected and found to be intact and leak test was performed with rigid proctoscope and was definitively negative.  An omental pedicle was then mobilized and brought down into the pelvis and placed the tubing the anterior rectum and bladder. Pneumoperitoneum was then taken down under direct vision as the ports were removed. Port sites were irrigated and reanesthesized and the anterior fascia of the small midline extraction site was closed with a # 1 PDS employing a running continuous suture. The skin was closed with a 3-) Biosyn employing a subcuticular suture and sealed with skin glue.
The patient tolerated the operation well. All sponge needle and instrument counts were correct. She was taken recovery in stable condition.

Findings: Colovaginal fistula, Colovesical fistula


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## cynthiabrown (Feb 2, 2016)

the closure of fistula is included in sigmoid resection............see ncci policy manual .Chapter 6


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## hcg (Mar 30, 2016)

cynthiabrown said:


> the closure of fistula is included in sigmoid resection............see ncci policy manual .Chapter 6




Thank you Cynthia. I appreciate the guidance


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