Summary & Overview
CPT 51925: Excision of Vesicouterine Fistula with Hysterectomy
CPT code 51925 represents surgical excision of a vesicouterine fistula performed with hysterectomy. This procedure is clinically significant because vesicouterine fistulae can cause urinary leakage, infection, and significant morbidity; combining fistula repair with hysterectomy may be indicated to remove diseased tissue and reduce recurrence. Nationally, the code is relevant to hospitals and ambulatory surgical centers that manage complex gynecologic and urologic reconstructive cases.
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, typical sites of service, and commonly reported use of the code. The publication summarizes benchmarking information where available, outlines coding and billing considerations tied to surgical service lines, and highlights policy and reimbursement issues that affect coverage and payment for complex pelvic reconstructive procedures.
The content provides operational clarity for billing teams, revenue cycle managers, and clinical leaders about how CPT code 51925 is used in practice, what clinical scenarios prompt its application, and which payers commonly process claims for this service. Data not available in the input will be noted explicitly in corresponding sections.
Billing Code Overview
CPT code 51925 describes a surgical procedure for removal of a vesicouterine fistula with concurrent hysterectomy. The procedure addresses an abnormal connection between the bladder and the uterus by surgically excising the fistulous tract and removing the uterus.
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Service type: Surgical procedure (reconstructive/abdominal pelvic surgery)
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Typical site of service: Hospital operating room or ambulatory surgical center where major gynecologic and urologic surgeries are performed.
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Clinical & Coding Specifications
Clinical Context
A 42-year-old woman with a history of multiple prior cesarean deliveries and chronic urinary leakage presents with recurrent urinary incontinence and cyclic vaginal bleeding. Imaging and cystoscopy identify a vesicouterine fistula—an abnormal communication between the bladder and the uterine cavity—resulting in urinary drainage through the uterus and intermittent urinary tract infections. Conservative management (catheter drainage, hormonal suppression) failed and the patient elects definitive surgical management. The surgical plan is planned transabdominal repair of the vesicouterine fistula with concomitant total abdominal hysterectomy due to uterine pathology and to reduce fistula recurrence. The procedure is performed in an operating room under general anesthesia with preoperative antibiotics and intraoperative cystoscopic evaluation. Postoperative care includes Foley catheter drainage for bladder healing, inpatient monitoring for hematuria and infection, pain control, and follow-up cystogram before catheter removal. Documentation should include preoperative diagnosis, informed consent, detailed operative findings, the surgical steps for fistula excision and hysterectomy, estimated blood loss, any intraoperative complications, and postoperative plan.
Coding Specifications
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