Summary & Overview
CPT 45825: Rectourethral Fistula Closure with Sigmoid Colostomy
CPT code 45825 represents a combined surgical approach to repair a rectourethral fistula with abdominal incision and simultaneous creation of a sigmoid colostomy to divert fecal flow and protect the repair. This complex reconstructive procedure is clinically important because rectourethral fistulae can cause significant morbidity, require multidisciplinary surgical care, and often necessitate staged management with fecal diversion. Nationally, recognition of appropriate coding for these procedures affects hospital case mix, resource allocation, and coverage determinations.
Key payers addressed in this summary include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The content outlines clinical context, coding scope, typical sites of service, and what to expect in payer coverage discussions for major national carriers.
Readers will gain a concise understanding of the clinical intent and service setting for CPT code 45825, how the procedure fits into colorectal and urologic reconstructive care, and the types of benchmarks and policy issues commonly reviewed by payers — including inpatient versus ambulatory surgical setting considerations, perioperative resource utilization, and documentation elements that support medical necessity. Data not available in the input: specific payer reimbursement rates, associated ICD-10 diagnosis codes, procedure modifiers, and related codes.
Billing Code Overview
CPT code 45825 describes a surgical procedure to close a rectourethral fistula by making an abdominal incision and closing the abnormal connection between the rectum and the urethra. The procedure also includes creation of a sigmoid colostomy that is brought to the abdominal surface to divert fecal stream and allow the fistula closure time to heal.
-
Service type: Surgical, colorectal/urologic reconstructive procedure
-
Typical site of service: Inpatient hospital or ambulatory surgical center (operating room) with postoperative inpatient observation as indicated
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult male presenting with urinary tract infections, pneumaturia, fecaluria, or recurrent urinary leakage following pelvic surgery, trauma, radiation, or inflammatory bowel disease. Diagnostic workup includes history, physical exam, cystoscopy, contrast studies (fistulogram, CT cystography), and colon evaluation. After confirming a rectourethral fistula that is unlikely to close spontaneously or that requires definitive repair, the surgical team plans an open abdominal approach to excise and close the fistulous tract and create a diverting sigmoid colostomy. The patient is brought to the operating room under general anesthesia. The surgeon makes an abdominal incision to access the rectum and urethra, isolates and repairs the fistula with layered closure and tissue interposition as indicated, and matures a sigmoid colostomy on the abdominal wall to divert fecal stream and protect the repair. Postoperative management includes urinary catheter drainage, stoma care education, intravenous antibiotics as indicated, pain control, and follow-up imaging or cystography to confirm healing prior to colostomy reversal planning. Typical sites of service are inpatient acute care hospital or tertiary specialty center with access to colorectal and urologic surgical teams.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier—default for procedures | Use when no specific modifier applies. |
| 11 | Office or other outpatient services (note: typically not used for major inpatient surgery) | Generally not applicable for this major inpatient procedure; included in list but rarely used here.