Summary & Overview
CPT 51900: Vesicovaginal and Urethrovaginal Fistula Repair
CPT code 51900 covers surgical repair of vesicovaginal and urethrovaginal fistulas — openings between the vagina and the urinary bladder or urethra that often follow obstetric or gynecologic surgery. This procedure addresses significant patient morbidity, including continuous urinary leakage, recurrent infections, and psychosocial impacts. Nationally, accurate coding for fistula repair supports appropriate surgical care documentation, quality measurement, and payment consistency for complex pelvic reconstructive procedures.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the code, typical sites of service, and the common administrative considerations tied to billing and coverage. The publication summarizes national benchmarks where available, highlights payer coverage patterns, and reviews policy and coding guidance relevant to surgical fistula repair. Content is designed to help coding professionals, billing staff, and policy analysts understand how CPT code 51900 is used and where to focus documentation to reflect the clinical complexity of these repairs.
Data not available in the input for specific associated taxonomies, ICD-10 diagnoses, related codes, payer-specific reimbursement rates, and detailed utilization statistics.
Billing Code Overview
CPT code 51900 describes surgical repair of a vesicovaginal or urethrovaginal fistula, an abnormal opening between the vagina and the urinary bladder or urethra. These fistulas frequently arise after obstetric or gynecologic procedures and cause urinary leakage and significant morbidity.
Service Type: Surgical repair of genitourinary fistula
Typical Site of Service: Hospital operating room or ambulatory surgery center, depending on patient condition and surgical approach.
Clinical & Coding Specifications
Clinical Context
A 42-year-old woman presents with continuous urinary leakage following a complicated hysterectomy performed six weeks earlier for symptomatic uterine fibroids. She reports constant vaginal drainage of urine, recurrent urinary tract infections, and periurethral skin irritation. Physical exam and dye test confirm a vesicovaginal fistula. Preoperative evaluation includes urinalysis, urine culture, pelvic exam, cystoscopy to locate the fistula, and imaging if needed. The surgical plan is an elective transvaginal or transabdominal repair under general anesthesia with perioperative antibiotic prophylaxis, ureteral assessment or stenting as indicated, and placement of a Foley catheter post-repair for bladder drainage. Typical site of service is an operating room in an ambulatory surgery center or hospital inpatient setting depending on comorbidities and anticipated complexity. Usual clinical workflow: consultation and informed consent, preoperative testing, intraoperative localization and repair of the fistula, immediate postoperative monitoring, inpatient observation or same-day discharge based on status, and follow-up for catheter removal and healing assessment.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required is substantially greater than typically required (extensive fibrosis, prior failed repairs). |