Urology Coding Alert

Question: How should I code a resection of a vesicosigmoid fistula?

North Carolina Subscriber

Answer: Look at codes CPT 44660 (Closure of enterovesical fistula; without intestinal or bladder resection) and 44661 (...with intestine and/or bladder resection). Append ICD-9 code 596.1 (Intestinovesical fistula, passage between bladder and intestine, fistula: enterovesical, vesicocolic, vesicoenteric, and vesicorectal). When a general surgeon and urologist perform these two procedures together at the same session, bill as co-surgeons with modifier 62 (Two surgeons) in one of these ways:

• 44660-62 for the general surgeon and 44660-62 for the urologist, or

• 44661-62 for the general surgeon and 44661-62 for the urologist.

Documentation should include a detailed operative report for each surgeon and what part of the procedure each performed. Also include a cover letter from each physician explaining in layman's terms what each performed and why. The general surgeon and urologist will split an increased global fee of 125 percent, each receiving 62.5 percent of the increased global payment.