Summary & Overview
CPT 57308: Rectovaginal Fistula Repair via Perineal Approach
CPT code 57308 describes surgical closure of a rectovaginal fistula performed via a perineal incision, including perineal repair and optional levator muscle shortening. This procedure addresses abnormal communication between the rectum and vagina that can cause significant morbidity and impact quality of life. Nationally, accurate coding for this operation affects surgical quality tracking, reimbursement pathways, and care coordination between colorectal and gynecologic surgical services.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical indication and operative approach associated with CPT code 57308, common billing modifiers and their typical uses, and how this code fits into surgical service lines. The publication also summarizes typical sites of service and contextualizes coding with related service-level considerations.
This report is intended for billing professionals, surgical coders, and clinical leaders who need a concise reference for CPT code 57308. It highlights coding essentials, common modifiers, and where to look for additional documentation and policy guidance. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 57308 describes a surgical procedure to close a rectovaginal fistula through a perineal incision. The provider performs closure of the fistula and repairs the perineum, with the option to shorten the levator muscle when necessary as part of the same procedure.
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Service type: Surgical repair of rectovaginal fistula via perineal approach
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Typical site of service: Operating room or ambulatory surgical center with perineal surgical capabilities
Clinical & Coding Specifications
Clinical Context
A typical patient is a 28–55-year-old cisgender woman presenting with a persistent rectovaginal fistula causing passage of flatus or stool through the vagina, recurrent vaginal or perineal infections, and social/sexual dysfunction. Conservative measures including bowel regimen, antibiotics, and local wound care have failed, or the fistula is persistent after obstetric injury or prior pelvic surgery. Preoperative evaluation includes history and pelvic exam, endoanal or transvaginal ultrasound and/or MRI to define tract and sphincter involvement, and bowel prep as indicated. The procedure is performed in the operating room under regional or general anesthesia. The surgeon makes a perineal incision to expose and excise the fistulous tract, repairs the rectal and vaginal defects in layered fashion, and reconstructs and repairs the perineum; levator muscle plication or shortening may be performed when necessary for support. Postoperative care includes antibiotics as indicated, stool softeners, pelvic rest, wound care, and follow-up to assess healing and continence. Typical site of service is an ambulatory surgical center or hospital operating room. Service type is a surgical repair (open perineal approach) for rectovaginal fistula closure.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work or complexity substantially exceeds usual for 57308 (document rationale). |