Summary & Overview
CPT 45800: Open Abdominal Repair of Rectovesical Fistula
CPT code 45800 represents open abdominal surgical repair of a rectovesical fistula, a clinically significant procedure to close an abnormal communication between the rectum and urinary bladder. Nationally, repair of rectovesical fistulae matters because these conditions can cause serious morbidity, recurrent infections, and impaired quality of life; timely definitive surgical repair is a key element of care pathways for affected patients.
Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The content addresses how the procedure is coded and billed under CPT code 45800, and provides contextual clinical information relevant to coverage and claims processing across major public and commercial payers.
Readers will find a concise overview of clinical intent and typical settings for the service, benchmark and policy-relevant topics commonly associated with surgical fistula repair, and guidance on what documentation and coding elements are central to claims adjudication. Data not provided in the input are noted as unavailable; the material focuses on national relevance rather than state-specific rules. This summary equips coding managers, revenue integrity teams, and clinical leaders with a clear, practical understanding of what CPT code 45800 denotes and why accurate coding matters for patient care and payer interactions.
Billing Code Overview
CPT code 45800 describes a surgical procedure in which an incision is made in the abdomen to close an abnormal connection between the rectum and the urinary bladder, known as a rectovesical fistula. The procedure involves direct surgical repair of the fistulous tract to restore normal separation between the urinary and gastrointestinal tracts.
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Service type: Open abdominal surgical repair of a rectovesical fistula
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Typical site of service: Inpatient or outpatient hospital operating room, depending on clinical severity and patient condition
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 52-year-old male presents with recurrent urinary tract infections, pneumaturia, and fecaluria following a complicated diverticulitis episode and prior pelvic surgery. Imaging with CT cystography and colonoscopy confirms a rectovesical fistula connecting the rectum to the urinary bladder. After urology and colorectal surgery consultation, the patient is scheduled for an open abdominal repair of the rectovesical fistula under general anesthesia. The clinical workflow includes preoperative evaluation (labs, urine culture, bowel preparation as indicated), intraoperative cystoscopic localization and Foley catheter placement, abdominal incision and mobilization of the involved bowel and bladder segments, fistula tract excision and layered closure of the bladder and rectal defects with or without tissue interposition, intraoperative leak testing, and placement of drains and urinary drainage. Postoperative care involves bladder decompression, antibiotics guided by cultures, bowel rest advancing diet as tolerated, wound and drain management, and follow-up imaging or endoscopic evaluation if clinically indicated. The procedure corresponds to an open abdominal approach to close a rectovesical fistula and is reported with 45800.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier specified / not used for reporting | Data not typically appended; subject to payer rules |