Summary & Overview
CPT 44660: Closure of Enterovesical Fistula
CPT code 44660 denotes the surgical closure of an enterovesical fistula, a repair that separates the small intestine from the urinary bladder to prevent recurrent infections and other serious complications. This procedure has national relevance because enterovesical fistulas carry risks of morbidity, repeated hospitalizations, and complex postoperative care, making accurate coding essential for care coordination and reimbursement.
Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical intent and typical settings for the procedure, plus benchmarking context where available. The publication outlines common billing modifiers used with surgical CPT codes and highlights considerations for site-of-service classification, operative complexity, and documentation elements that support medical necessity.
This summary provides clinical context for hospital and surgical coding teams, revenue cycle professionals, and policy analysts. It clarifies what the code represents, the typical care environment, and the payer landscape addressed. Data not available in the input is noted where applicable and omitted from sections that require specific payer policy details or diagnosis mappings.
Billing Code Overview
CPT code 44660 describes the surgical closure of an enterovesical fistula — an abnormal connection between the small intestine and the urinary bladder. The procedure is performed to eliminate the pathological passage that can cause recurrent urinary tract infections, fecaluria, urinary leakage, or other complications related to contamination between the gastrointestinal and genitourinary tracts.
Service type: Surgical procedure (open or potentially minimally invasive operative repair) performed by a general surgeon or colorectal surgeon to excise and close the fistulous tract and restore normal separation between bowel and bladder.
Typical site of service: Inpatient hospital operating room or ambulatory surgical center, depending on patient condition, complexity of the fistula, and perioperative needs.
Clinical & Coding Specifications
Clinical Context
A 68-year-old male presents with recurrent urinary tract infections, pneumaturia, and fecaluria three months after complicated diverticulitis managed conservatively. Imaging with CT abdomen/pelvis demonstrates an enterovesical fistula connecting a segment of sigmoid colon to the dome of the urinary bladder. After multidisciplinary review, the patient is taken to the operating room for definitive surgical management: resection of the diseased bowel segment and closure of the enterovesical fistula with primary bladder repair. The typical workflow includes preoperative optimization (antibiotics, bowel preparation if indicated), general anesthesia, abdominal exploration via open or laparoscopic approach, identification and mobilization of the fistulous tract, separation of the bladder from bowel, resection or debridement of involved bowel as required, closure of the bladder defect (often in two layers), leak testing, placement of urinary drainage (Foley catheter ± suprapubic tube), possible diversion or stoma depending on contamination and bowel viability, and postoperative monitoring for infection, urine leak, and return of bowel function. Typical site of service is an inpatient surgical setting (operating room) with postoperative hospitalization. Service type is major abdominal/pelvic surgical procedure to close an enterovesical fistula (44660).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No specialty indicated (placeholder) |