Summary & Overview

CPT 45820: Abdominal Repair of Rectourethral Fistula

CPT code 45820 denotes an abdominal surgical repair to close a rectourethral fistula — an abnormal connection between the rectum and urethra. This repair is a specialized procedure typically performed in an operating room setting and is relevant to urology and colorectal surgical practice. Nationally, accurate coding for complex fistula repairs affects payment, quality reporting, and care coordination for patients with pelvic trauma, malignancy, radiation injury, or complications of prior surgery.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for the procedure, common service settings, and typical billing considerations for major national payers. The report outlines benchmarks and reimbursement context where available, highlights coding clarity for surgical repair of rectourethral fistula, and summarizes areas where policy updates or payer-specific rules may influence claims processing. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 45820rectourethral fistulafistula repairurology surgeryabdominal surgical repairoperating roomsurgical codingprocedure coding

Billing Code Overview

CPT code 45820 describes a surgical procedure in which an incision is made in the abdomen to close an abnormal connection between the rectum and the urethra, known as a rectourethral fistula. This procedure is a surgical repair of a rectourethral fistula.

Service type: Abdominal surgical repair of fistula
Typical site of service: Hospital operating room or ambulatory surgery center

Clinical & Coding Specifications

Clinical Context

A typical patient is a male adult presenting with recurrent urinary tract infections, pneumaturia, fecaluria, or persistent urinary leakage after prostate surgery or pelvic trauma. Evaluation includes history, physical exam, cystoscopy, and imaging (CT cystography or contrast studies) confirming a rectourethral fistula. Surgical planning occurs in a tertiary care setting with colorectal and urologic surgeons coordinating care. The procedure 45820 is performed in an operating room under general anesthesia via an abdominal incision to identify, mobilize, and close the abnormal communication between the rectum and urethra; fecal diversion (colostomy) may be performed preoperatively or concurrently depending on contamination and healing risk. Perioperative workflow includes preoperative antibiotics, bowel preparation as indicated, intraoperative cystoscopic assessment, multilayer closure of urethral and rectal defects, potential tissue interposition (e.g., gracilis or omental flap), and postoperative urinary diversion with Foley or suprapubic catheter. Typical sites of service are inpatient hospital operating rooms or ambulatory surgical centers for select stable patients. Common comorbid considerations include prior pelvic irradiation, Crohn disease, malignancy, and prior pelvic surgery, which influence approach and postoperative monitoring.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier — standard submission	Use when no other modifier applies and the service is billed as routine.
`22`	Increased procedural services	Use when work required is substantially greater than typically required (e.g., extensive adhesiolysis, complex reconstruction).
`23`	Unusual anesthesia	Use when procedure is performed under local or minimal anesthesia for a patient for whom general anesthesia is contraindicated.
`50`	Bilateral procedure	Generally not applicable to `45820`; include only if documentation supports bilateral distinct procedures (rare).
`51`	Multiple procedures	Use when `45820` is performed with other distinct surgical procedures during the same operative session.
`52`	Reduced services	Use when the procedure is partially reduced or not completed as originally planned.
`53`	Discontinued procedure	Use when the procedure is started but stopped due to unforeseeable circumstances.
`62`	Two surgeons	Use when two surgeons from different specialties (e.g., urology and colorectal surgery) operate together and each documents active participation.
`63`	Procedure performed on infants <4 kg	Rare for this code; use only if patient meets weight criteria (neonatal cases).
`78`	Return to OR for related procedure during global period	Use when an unplanned return to the OR for a related procedure occurs during the global postoperative period.
`80`	Assistant surgeon	Use when an assistant surgeon provides qualified assistance.
`81`	Minimum assistant surgeon	Use when a physician assistant or other qualifies as a minimum assistant per payer rules.
`82`	Assistant surgeon when qualified resident not available	Use when an assistant surgeon is required because no qualified resident is available.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist	Use to indicate services furnished by these nonphysician practitioners where allowed.

Taxonomy Code	Specialty	Notes
208000000X	Colon & Rectal Surgery	Specialists in complex rectal reconstruction and fistula repair.
208800000X	Urology	Urologists manage urethral repair and urinary diversion.
207L00000X	General Surgery	General surgeons with colorectal expertise perform abdominal approaches and diversion.
207P00000X	Surgery – Pediatric (if pediatric patients)	Pediatric surgeons manage congenital or neonatal rectourethral fistulas.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K60.3`	Fistula of anus and rectum	May represent adjacent anorectal disease leading to secondary rectourethral fistula formation.
`K63.2`	Fistula of intestinal tract, not elsewhere classified	Captures enteric fistulas including rectourethral communications when more specific code is not available.
`N36.2`	Urethral fistula	Directly relevant when a fistulous connection involves the urethra.
`N99.89`	Other postprocedural complications and disorders of genitourinary system	Captures complications such as iatrogenic fistula following prostate or pelvic surgery.
`K50.10`	Crohn disease of small intestine without complications	Crohn disease is a risk factor for fistula formation; include more specific Crohn codes as appropriate.
`C61`	Malignant neoplasm of prostate	Pelvic malignancy or its treatment (surgery/radiation) can lead to fistula formation between rectum and urethra.
`S31.89`	Other open wound of abdominal wall	Trauma-related injuries that result in pelvic or perineal disruption leading to fistula.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`44120`	Enterolysis, chemical or mechanical, for obstruction; 1 or more sites, abdominal	Performed when extensive adhesions are encountered and require lysis to access fistula.
`44625`	Colostomy, creation or revision, with mucous fistula	Performed when fecal diversion is needed either prior to or concurrent with fistula repair.
`53970`	Repair urethral fistula, suprapubic or perineal approach	Alternative or adjunct urethral fistula repairs depending on location and approach; may be used when perineal approach is chosen.
`57425`	Colpoplasty, repair of rectovaginal or rectourethral fistula (may be used for pelvic fistula repairs)	Used when vaginal or pelvic approaches are employed for fistula repair in select cases.
`49905`	Colon resection with colostomy (partial)	Performed when diseased rectal tissue requires resection along with creation of diversion in complex cases.