Summary & Overview
CPT 57307: Excision of Rectovaginal Fistula with Colostomy Creation
CPT code 57307 represents an abdominal surgical procedure that excises a rectovaginal fistula and creates a colostomy by externalizing the colon to divert stool. This code is used for definitive surgical management of complex anorectal fistulas involving the rectovaginal septum and carries significance for national surgical case mix, resource utilization, and hospital perioperative planning.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical intent and typical sites of service, an explanation of the procedure�s coding context, and the types of benchmarks and policy elements commonly associated with complex abdominal fistula repair and colostomy creation. The publication outlines what to expect in payer coverage review and claims processing for major commercial insurers and Medicare, highlights common billing and documentation considerations relevant to the procedure, and summarizes the clinical circumstances that typically prompt use of this code.
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes. The content focuses on national clinical and coding context rather than state-specific policies.
Billing Code Overview
CPT code 57307 describes an abdominal surgical procedure in which the provider excises a rectovaginal fistula and creates a colostomy by bringing one end of the colon out through the abdominal wall so stool is diverted through a new artificial opening. This is an abdominal approach procedure.
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Service type: Abdominal surgical excision of rectovaginal fistula with colostomy creation
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Typical site of service: Inpatient or outpatient hospital operating room, depending on clinical complexity and perioperative needs
Clinical & Coding Specifications
Clinical Context
A typical patient is a woman in her 40s–60s presenting with fecal drainage from the vagina, recurrent pelvic pain, and recurrent pelvic or perineal infection after obstetric trauma, inflammatory bowel disease, or pelvic surgery. Evaluation includes history and physical, pelvic exam noting an external vaginal opening with stool or gas passage, stool studies, pelvic imaging (pelvic MRI or CT), and colonoscopy to evaluate the colon and rule out active distal disease. The surgical plan is an abdominal approach for excision of a rectovaginal fistula with creation of a colostomy (end colostomy/colostomy formation) to divert fecal stream.
Preoperative workflow includes bowel preparation as indicated, informed consent that documents indication and risks, pre-op anesthesia evaluation, and documentation of contingency plans (fistula excision with colostomy). Intraoperative documentation should describe the abdominal approach, identification and excision of the fistula tract, resection of diseased colon when performed, and exteriorization of the proximal bowel as a stoma on the abdominal wall. Postoperative workflow includes stoma care planning, wound and infection monitoring, and coordination with colorectal surgery, ostomy nursing, and planning for potential future stoma reversal when clinically appropriate.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default or no modifier reported | Rarely used; may appear in proprietary systems but not standard for CMS claims |