Summary & Overview
CPT 57305: Abdominal Excision of Rectovaginal Fistula
CPT code 57305 denotes the abdominal excision of a rectovaginal fistula, a surgical procedure used to remove a pathological connection between the rectum and vagina. Nationally, this code captures definitive operative management for a condition that can cause significant morbidity, impact quality of life, and require multidisciplinary care. Accurate coding supports appropriate claims processing, quality measurement, and tracking of surgical outcomes.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for 57305, typical sites of service, and common billing modifiers and workflows relevant to surgical services. The publication highlights benchmarking information, coding considerations, and recent policy or payment updates that typically affect surgical inpatient and outpatient billing for complex pelvic procedures.
This summary is designed to help billing managers, surgical service line leaders, and policy analysts understand where 57305 fits in clinical practice and payer processes, what documentation and coding elements are commonly reviewed, and what to expect in standard payer coverage and claim adjudication. Data not available in the input is identified where applicable.
Billing Code Overview
CPT code 57305 describes a surgical procedure in which the provider excises a rectovaginal fistula through an abdominal incision. This procedure represents definitive surgical management aimed at removing the fistulous tract connecting the rectum and vagina.
Service type: Surgical procedure — abdominal excision of rectovaginal fistula
Typical site of service: Hospital operating room or ambulatory surgical center
Clinical & Coding Specifications
Clinical Context
A typical patient is a 35–60-year-old woman presenting with a symptomatic rectovaginal fistula causing passage of stool or gas through the vagina, recurrent vaginal or perineal infection, and chronic local irritation. Most candidates have a prior obstetric injury, obstetric laceration repair failure, inflammatory bowel disease (eg, Crohn disease), pelvic radiation history, or prior colorectal or gynecologic surgery. Evaluation includes pelvic and rectal examination, endoanal ultrasound or magnetic resonance imaging to delineate the fistula tract, and colonoscopy when inflammatory bowel disease is suspected.
Surgical workflow for an abdominal excision approach (57305) typically includes preoperative bowel preparation and antibiotics, general anesthesia, an abdominal (often lower midline or Pfannenstiel) incision, mobilization of the rectum and vagina, identification and complete excision of the fistula tract with layered repair of both rectal and vaginal defects, possible interposition flap or omental pedicle if indicated, hemostasis, and abdominal wound closure. Postoperative care includes bowel regimen, stool softeners, wound and pelvic hygiene instructions, and follow-up imaging or anoscopy as indicated to confirm healing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the operative report documents substantially greater work than typical for , with supporting documentation of why increased resources were required. |