Summary & Overview

CPT 51920: Vesicouterine Fistula Excision and Repair

CPT code 51920 represents the surgical excision and repair of a vesicouterine fistula, an abnormal tract between the bladder and uterus. As a specialized genitourinary/gynecologic surgical procedure, it carries implications for facility resource use, operative scheduling, and post‑operative care coordination. Nationally, accurate coding supports proper claims processing, utilization tracking, and quality measurement for complex pelvic reconstructive surgeries.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for the procedure, typical settings where the service is delivered, and the types of benchmarks and policy considerations commonly associated with surgical fistula repair — including coding specificity, site‑of‑service implications, and payer coverage patterns. The publication outlines common modifiers used in surgical billing, potential documentation elements relevant to claims adjudication, and where data are unavailable.

This summary equips billing managers, surgical practices, and policy analysts with a concise reference to what CPT code 51920 denotes, why precise coding matters for national reporting and reimbursement workflows, and the categories of information to review when preparing or auditing claims for vesicouterine fistula repair.

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Billing Code Overview

CPT code 51920 describes the surgical removal of a vesicouterine fistula, an abnormal connection between the bladder and the uterus. The procedure involves excision of the fistulous tract and repair of the involved organs to restore normal anatomic separation and function.

Service type: Surgical, genitourinary/gynecologic repair

Typical site of service: Hospital operating room or ambulatory surgical center

Clinical & Coding Specifications

Clinical Context

A typical patient is a reproductive-age or perimenopausal woman presenting with urinary leakage, recurrent urinary tract infections, pelvic pain, or abnormal vaginal or uterine discharge after prior cesarean delivery, hysterectomy, uterine instrumentation, or pelvic surgery. Workup includes history and physical exam, urinalysis and urine culture, pelvic exam, imaging with cystography or CT cystography, and cystoscopic evaluation demonstrating an opening between the bladder and the uterus. Preoperative planning involves counseling, optimization of infection or anemia, bowel and bladder preparation as indicated, informed consent, and coordination with anesthesia. The procedure, 51920, is performed in an operating room setting under general or regional anesthesia. Intraoperative steps include exposure of the vesicouterine tract, careful dissection to separate bladder and uterine tissues, excision of the fistulous tract, multilayer closure of bladder and uterine defects, possible interposition graft or omental flap, leak testing (cystography or methylene blue), and placement of urinary drainage (Foley catheter) for postoperative bladder rest. Postoperative care includes catheter management, antibiotics as indicated, pain control, monitoring for hematuria or urinary retention, and follow-up imaging or cystography prior to catheter removal to confirm closure.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work, time, or intensity substantially exceeds typical for `51920` and documented accordingly.
`23`	Unusual anesthesia	Use when general anesthesia is contraindicated and anesthesia is provided for unusual circumstances (rare for this pelvic procedure).
`26`	Professional component	Use only if separate professional component reporting is applicable for a diagnostic service bundled with the operative report (rare for `51920`).
`50`	Bilateral procedure	Use if separate bilateral fistula repairs are performed and payer allows bilateral modifier for this specific procedure.
`51`	Multiple procedures	Use when `51920` is performed with additional distinct procedures the same day to indicate multiple procedures.
`52`	Reduced services	Use when the service is partially reduced or not completed as documented (e.g., attempted repair converted to a limited procedure).
`53`	Discontinued procedure	Use when procedure is started but discontinued for patient-related or intraoperative reasons.
`62`	Two surgeons	Use when two surgeons of different specialties perform distinct portions of the procedure concurrently and both are documented.
`63`	Procedure performed on infants less than 4 kg	Not typically applicable; include only if patient meets weight criteria.
`78`	Unplanned return to operating room	Use for a related procedure during the postoperative global period for complications requiring return to the OR.
`80`	Assistant surgeon	Use when an assistant surgeon is present and payer accepts modifier for assistant at surgery.
`81`	Minimum assistant surgeon	Use when minimal assistance is documented and payer recognizes `81`.
`82`	Assistant (when a qualified resident surgeon is not available)	Use when assistant is necessary and resident not available.
`TC`	Technical component	Use only if a separately reportable technical component applies (rare for this surgical service).

Taxonomy Code	Specialty	Notes
`207VP0200X`	Obstetrics & Gynecology	Gynecologic surgeons routinely evaluate and repair vesicouterine fistulae.
`207VC0000X`	Urology	Urologists perform bladder dissection, repair, and assist with complex fistula repairs.
`2080P0205X`	Female Pelvic Medicine & Reconstructive Surgery	Specialists for complex pelvic fistula repair and reconstructive techniques.
`208800000X`	General Surgery	General surgeons may be involved for abdominal approach or combined procedures.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N32.2`	Vesicovaginal fistula	Nearby pelvic fistulas can coexist; differential diagnosis to distinguish from vesicouterine fistula.
`N82`	Fistula and perforation of female pelvic organs	Broad category capturing pelvic fistula conditions including vesicouterine fistula.
`N99.8`	Other postprocedural complications and disorders of genitourinary system, not elsewhere classified	Used for postoperative complications related to prior uterine or bladder surgery that may lead to fistula formation.
`O71.5`	Traumatic rupture of bladder during delivery (intrapartum)	Obstetric injury that can result in abnormal communications involving uterus and bladder.
`N30.9`	Cystitis, unspecified	Recurrent or chronic bladder infection is commonly associated and may prompt evaluation leading to fistula diagnosis.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`52000`	Cystourethroscopy, diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)	Diagnostic cystoscopy performed preoperatively or intraoperatively to localize the fistula opening and assess bladder mucosa.
`51702`	Simple cystostomy or suprapubic catheter placement	May be performed before or after repair to divert urine and provide bladder drainage for healing.
`57240`	Vaginal fistula repair with or without tissue interposition (may include bladder or rectovaginal components)	Alternative or adjunct procedure if vaginal approach is used or combined fistula types are present.
`49560`	Repair of recurrent or incisional hernia may be performed concurrently	Included as an example of an additional procedure that could be billed the same day when multiple procedures are necessary; use `51` modifier as appropriate.
`51701`	Complex suprapubic catheter placement or exchange under anesthesia	Used when more complex urinary diversion is required in perioperative management.