# Laparoscopic colovaginal fistula takedown



## pkoens (Aug 11, 2010)

Good morning...my doctor did a hand assisted laparoscopic Hartmann procedure with takedown of a colovaginal fistula.  I was going to use 44206 for the Hartmann, however, the only code I find for the fistula is 57305-57307which is not laparoscopic.  Any help with this is appreciated.


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## acbarnes (Aug 11, 2010)

We see these alot. There is no lap takedown for the colovaginal fistula. We bill these as unlisted lap with mod 59. You have to be careful though because alot of carriers want to bundle it. It helps if you can give 1 diagnosis for the Hartmen (diverticulitis) and another for the takedown (colovaginal fistula). If the diagnosis is the same then use lap hartmen with 22 if you can prove with the op report that the takedown added significant time, difficulty, and risk. 

Also, 57300-57308 are for rectovaginal takedowns, not colovaginal. My Mds define a colovaginal takedown when other sections of the bowels (not rectum) develop a fistula with the vaginal. This usually happens in cases in which the patient does not have a uterus (post hysterectomy). They differeniate between a rectovaginal and colovaginal. I would love to get feedback on this.....

Anna Barnes, CPC, CEMC


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## pkoens (Aug 11, 2010)

Anna..thank you so much for the information....he does mention inflammatory process of both the rectovaginal area as well as the sigmoid colon, but my thinking is that the 57300-57308 codes are not for laparoscopic procedures, so either 44206-22 or unlisted lap w/59 would be better choices even if we are looking at a rectovaginal fistula...am I correct?


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## preserene (Aug 11, 2010)

I take the note from you that it was a hand assisted procedure right!? or
Was it a laparoscopy assisted colostomy closure after Hartmann(Laparoscopic reversal of Hartmann procedure or laparoscopy assisted colectomy with dexterity pneumo sleeve procedure- *which uses the minilaparotomy for colostomy mobilization to apply the Dexterity(R) Pneumo Sleeve(TM) device- with the direct access of the surgeon's hand to the patient's abdomen. *That means it was a combined approach open abdominal and laparoscopic. 
while that is the scenerio for your surgical procedure, why don't we liberally take it down for the Colovaginal/or Rectovaginal fistula repair done by abdominal approach, with concomitant colostomy-code *57307*Yes indeed colovaginal is avery very rare entity but still moments like this when physician did he did indeed. That is not our point at this juncture,any way
Your Physician can always provide a detailed report of the  necessitated and mandatory procedure and let them get paid for what they do really deserve.

RVF /CVF/VVF whatever vaginal fistula is a real major cumbersome surgical procedure of its own and it deserves a separate coding assignment. It can not be mended by way of appending a modifier for a major distinct procedure like this
This my polite openion for the discussion point of view!
Thank you


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## preserene (Aug 11, 2010)

I take the note from you that it was a hand assisted procedure right!? or
Was it a laparoscopy assisted colostomy closure after Hartmann(Laparoscopic reversal of Hartmann procedure or laparoscopy assisted colectomy with dexterity pneumo sleeve procedure- *which uses the minilaparotomy for colostomy mobilization to apply the Dexterity(R) Pneumo Sleeve(TM) device- with the direct access of the surgeon's hand to the patient's abdomen. *That means it was a combined approach open abdominal and laparoscopic. 
while that is the scenerio for your surgical procedure, why don't we liberally take it down for the Colovaginal/or Rectovaginal fistula repair done by abdominal approach, with concomitant colostomy-code *57307*Yes indeed colovaginal is avery very rare entity but still moments like this when physician did he did indeed. That is not our point at this juncture,any way
Your Physician can always provide a detailed report of the  necessitated and mandatory procedure and let them get paid for what they do really deserve.

RVF /CVF/VVF whatever vaginal fistula is a real major cumbersome surgical procedure of its own and it deserves a separate coding assignment. It can not be mended by way of appending a modifier for a major distinct procedure like this
This my polite openion for the discussion point of view!
Thank you


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## acbarnes (Aug 12, 2010)

You are right that 57300-57307 are open codes. If your MD performed it lap or hand assisted lap I would bill unlisted lap. We do this pretty routinuely with the lap bowel resections and colovaginal/rectovaginal fistulas. We get paid with most carriers on review. 

Preserene is correct about the modifier. I do not append 59 to the unlisted code. I was thinking about another unlisted procedure we perform that we do have to append 59 for a particular carrier on a specific procedure. 

Anna Barnes, CPC, CEMC


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## ychadha21 (Aug 31, 2022)

PROCEDURES:
1. EXAMINATION UNDER ANESTHESIA, PROCTOSIGMOIDOSCOPY. * 45990*
2. EXPLORATORY LAPAROTOMY, TAKEDOWN OF COLOVAGINAL FISTULA, SIGMOID RESECTION AND PRIMARY COLORECTAL ANASTOMOSIS. can someone help with this 2nd one .


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