CPT 45805 Rectovesical Fistula Repair Reimbursement | OpenPayer

Summary & Overview

CPT 45805: Rectovesical Fistula Repair with Sigmoid Colostomy

CPT code 45805 represents an abdominal surgical repair of a rectovesical fistula with creation of a sigmoid colostomy to divert fecal flow while the repair heals. This procedure addresses a complex pelvic-thoracic communication that can cause infection, urinary contamination, and significant morbidity; proper coding and coverage determination affect access to definitive surgical care and hospital resource use. Key national payers examined include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the code, the expected service setting and procedural intent, and the typical payers involved in coverage determinations. The publication outlines where this code sits in clinical workflows — major abdominal operation under general anesthesia with colostomy creation — and highlights the types of information payers and providers commonly review during authorization and claims adjudication. It also points readers to benchmarks and policy considerations relevant to surgical coding, inpatient versus outpatient site-of-service implications, and documentation elements that support medical necessity. Data not available in the input for specific modifiers, associated taxonomies, ICD-10 diagnoses, and related billing codes is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare45805CPTfistula-repaircolostomyabdominal-surgerygeneral-surgeryoperative-proceduresurgical-codinginpatient-surgery

Billing Code Overview

CPT code 45805 describes a surgical procedure to close a rectovesical fistula — an abnormal connection between the rectum and urinary bladder — by making an incision in the abdomen. The procedure includes creation of a sigmoid colostomy on the abdominal surface to divert fecal flow and allow the fistula repair time to heal.

Service type: Surgical procedure, fistula repair with diversion colostomy
Typical site of service: Inpatient or outpatient hospital operating room (abdominal surgery requiring general anesthesia)

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is a middle-aged to older male who develops a rectovesical fistula, commonly after pelvic surgery, severe diverticulitis, radiation injury, Crohn disease, or malignancy involving the rectum or bladder. The patient presents with recurrent urinary tract infections, fecaluria (passage of fecal material in the urine), pneumaturia (air in the urine), suprapubic pain, and urinary frequency. Diagnostic workup includes pelvic imaging (CT or MRI), cystoscopy to visualize the bladder side of the fistula, and colonoscopy or sigmoidoscopy to evaluate the rectal mucosa.

Surgical workflow for 45805 typically involves general or colorectal surgery teams in an inpatient operating room under general anesthesia. The operation includes an abdominal incision to identify and close the rectovesical fistula with layered repair of the bladder and rectum as appropriate, followed by formation of a sigmoid colostomy brought to the abdominal wall to divert fecal stream and protect the repair. Intraoperative steps often include cystotomy or cystoscopy as needed, mobilization of the sigmoid colon, creation of a stoma, and placement of appropriate drains. Postoperative care includes inpatient monitoring for infection, urine and stoma output assessment, wound care, antibiotics, and urology/colorectal follow-up. Elective timing may be delayed until infection/inflammation is controlled; urgent repair may occur for sepsis or uncontrolled fistula complications.

Coding Specifications

Modifiers table

Modifier	Description	When to Use

CPT 45562: Exploratory Rectal Repair with Presacral Drainage

CPT-45540-ABDOMINAL-RECTOPEXY-RECTAL-PROLAPSE-MESH-SUTURE

CPT 45540: Abdominal Rectopexy for Rectal Prolapse

CPT-45560-RECTOCELE-REPAIR-VAGINAL

CPT 45560: Rectocele Repair (Vaginal)

CPT-45541-PERINEAL-RECTAL-PROLAPSE-REPAIR-MESH-SUTURES

CPT 45541: Perineal Rectal Prolapse Repair with Mesh and Sutures

CPT-45520-RECTAL-SCLEROTHERAPY-FOR-PROLAPSED-MUCOSA

CPT 45520: Injection of Sclerosant for Prolapsed Rectal Mucosa

CPT-45500-ANORECTAL-STENOSIS-RELEASE-WITH-FLAP-REPAIR

CPT 45500: Release of Anorectal Stenosis with Flap Repair

CPT-45505-RECTAL-MUCOSA-EXCISION-AND-FLAP-REPAIR

CPT 45505: Excision of Prolapsed Rectal Mucosa with Flap Repair

CPT-45550-RECTOPEXY-WITH-SIGMOID-RESECTION

CPT 45550: Open Rectopexy with Sigmoid Resection

CPT-45800-RECTOVESICAL-FISTULA-REPAIR-OPEN-ABDOMINAL

CPT 45800: Open Abdominal Repair of Rectovesical Fistula

CPT-45820-RECTOURETHRAL-FISTULA-REPAIR-ABDOMINAL-APPROACH

CPT 45820: Abdominal Repair of Rectourethral Fistula

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Taxonomy Code	Specialty	Notes
`207L00000X`	Colorectal Surgery	Primary specialty performing complex rectal and pelvic repairs and colostomy creation.
`208D00000X`	General Surgery	Frequently performs abdominal fistula repairs and stoma formation.
`2080P0106X`	Urology	Manages bladder repair and perioperative urinary tract care for rectovesical fistula.
`363L00000X`	Wound Care (Ostomy Care)	Provides peri- and post-operative stoma care and education.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K60.3`	Fistula of rectum and anus, unspecified	Represents enteric fistula involving rectum, clinically related to rectovesical fistula scenarios.
`K63.2`	Fistula of intestine	General intestinal fistula code applicable when documenting fistulous communications requiring diversion.
`N32.89`	Other specified disorders of bladder	Used when bladder injury or abnormal communication such as fistula is present.
`K50.114`	Crohn disease of small intestine with rectal bleeding	Crohn disease is a common cause of enterovesical or rectovesical fistula formation.
`C20`	Malignant neoplasm of rectum	Rectal malignancy can cause fistula formation to the bladder, necessitating surgical repair and diversion.
`K57.30`	Diverticulosis of large intestine without perforation or abscess	Complicated diverticulitis with fistula formation may be coded with diverticular disease codes when applicable.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`44187`	Laparoscopy, surgical, enterolysis (freeing intestinal adhesion) (separate procedure)	May be performed prior to or during `45805` if extensive adhesions are encountered during abdominal access.
`44615`	Excision of rectal tumor, partial; transabdominal approach	Performed when concomitant rectal pathology requires partial rectal resection in the same operative setting.
`51702`	Irrigation of bladder, simple (e.g., by catheter)	Postoperative bladder irrigation may be used in management after bladder repair; performed as a separate bedside service.
`44143`	Colectomy, partial; with colostomy or ileostomy	If a larger bowel resection is required in addition to colostomy, this colectomy code may be billed in the same episode.
`49900`	Exploratory laparotomy, exploratory celiotomy (separate procedure)	When an extensive abdominal exploration is required prior to definitive fistula repair, an exploratory laparotomy may be coded alongside or as the primary abdominal access code.

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