Summary & Overview
CPT 57300: Closure of Small Rectovaginal Fistula, Vaginal or Transanal
CPT code 57300 represents the surgical closure of small rectovaginal fistula tracts via a vaginal or transanal approach. The code matters nationally because rectovaginal fistulae, while relatively uncommon, require operative management that spans multiple surgical specialties and settings, affecting reimbursement, care pathways, and provider documentation practices. Clear coding supports appropriate payment and appropriate site-of-service reporting for procedures performed by obstetrician-gynecologists and gastrointestinal surgeons.
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 performed, and the code’s role in care delivery. The publication also summarizes common billing modifiers and related administrative considerations; however, specific modifier usage and payer-specific reimbursement rates are not included here if not provided.
This briefing provides clinicians, billing staff, and policy analysts with concise background on when and how CPT code 57300 is used, the specialties that commonly perform it, and the typical sites of service. It situates the code within broader surgical practice and billing workflows to support accurate claim submission and clinical documentation.
Billing Code Overview
CPT code 57300 describes a surgical procedure to close a small fistula tract between the rectum and the vagina using a vaginal approach or a transanal (through the anus) approach. The procedure targets small rectovaginal fistulae and involves direct closure of the tract. An obstetrician-gynecologist commonly performs the vaginal approach, while a gastrointestinal surgeon commonly performs the transanal approach.
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Service type: Surgical repair of rectovaginal fistula (local closure)
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Typical site of service: Ambulatory surgery center or hospital operating room, using a vaginal or transanal approach depending on clinician specialty and fistula characteristics
Clinical & Coding Specifications
Clinical Context
A typical patient is a woman presenting with fecal drainage or recurrent vaginal infections months after obstetric tearing or pelvic surgery. She reports passage of gas or stool through the vagina and has focal vaginal inflammation on exam. After evaluation with history, pelvic exam, and confirmatory testing (vaginal inspection, dye test, and/or anoscopy and possible imaging such as endoanal ultrasound or pelvic MRI), the diagnosis of a small rectovaginal fistula is confirmed. Conservative measures (diversion, local care, seton, or bowel regimen) have been considered and the surgical team determines the fistula tract is small and amenable to closure via a vaginal approach by an obstetric–gynecologic surgeon or via a transanal approach by a gastrointestinal surgeon.
The clinical workflow includes preoperative evaluation (consent, bowel prep if indicated, perioperative antibiotics), positioning and anesthesia (general or regional), exposure of the fistula via the vagina or anus, excision or freshening of the tract, layered closure of rectal and vaginal mucosa with appropriate sutures, and postoperative care with stool softeners and activity restrictions. Typical follow-up includes wound checks and reassessment for fistula recurrence or infection.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Unmodified procedure | Rarely used; indicates no modifier appended when required by payer. |