Summary & Overview
CPT 44661: Enterovesical Fistula Repair with Resection and Closure
CPT code 44661 denotes surgical repair of an enterovesical fistula through resection of the damaged intestinal and/or bladder tissue and closure of the wound. This procedure addresses an abnormal passage between the small intestine and urinary bladder, a condition that can cause recurrent urinary tract infections, sepsis risk, and significant morbidity. Nationally, billing and clinical clarity around 44661 matter for surgical departments, payers, and hospitals because the procedure often involves multidisciplinary care and may occur in inpatient or ambulatory surgical settings.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a concise view of clinical context, typical sites of service, common billing modifiers (listed separately), and the role of 44661 in surgical case mix and resource planning.
Readers will find: an explanation of what 44661 represents clinically and procedurally; typical settings where the service is delivered; guidance on common billing considerations and common modifiers (where provided); and a summary of issues relevant to coding, utilization, and documentation for surgical fistula repair. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 44661 describes surgical repair of an enterovesical fistula, an abnormal connection between the small intestine and the urinary bladder. The procedure involves resection of the affected portion of the intestine and/or bladder and closure of the fistulous tract to treat or prevent infection and other complications.
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Service type: Surgical procedure for fistula repair, including resection and closure
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Typical site of service: Inpatient or outpatient surgical setting, commonly performed in an operating room within a hospital or ambulatory surgical center
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult who presents with recurrent urinary tract infections, pneumaturia, fecaluria, or persistent abdominal and suprapubic pain following diverticular disease, Crohn disease, malignancy, prior pelvic radiation, or previous pelvic surgery. After history, physical exam, urinalysis, urine culture, CT abdomen/pelvis with contrast, cystoscopy, and possible colonoscopy confirm an enterovesical fistula, the patient is optimized preoperatively (antibiotics for infection, bowel preparation if indicated, cardiopulmonary risk assessment). The surgical workflow includes induction of general anesthesia in the operating room, exploratory laparotomy or laparoscopy, mobilization of the affected bowel segment, resection of the diseased intestinal segment with primary anastomosis or stoma creation as needed, identification and repair or partial cystectomy of the bladder defect, watertight bladder closure with or without omental interposition, intraoperative cystogram or bladder leak test, and placement of urinary catheter and drains. Postoperative care includes catheter management, monitoring for urinary leak or infection, pain control, venous thromboembolism prophylaxis, and follow-up imaging or cystography as indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier; standard reporting | Use when no special circumstances apply to the procedure. |