CPT 57311 Urethrovaginal Fistula Repair Reimbursement | OpenPayer

Summary & Overview

CPT 57311: Urethrovaginal Fistula Repair with Bulbocavernosus Muscle Flap

CPT code 57311 designates a surgical procedure to repair a urethrovaginal fistula using the bulbocavernosus muscle to create protective flaps over the repair. This reconstructive operation addresses abnormal communications between the urethra and vagina that can cause urinary leakage, recurrent infections, and functional impairment. The procedure is clinically significant given its role in restoring continence and pelvic floor integrity and is performed by gynecologic and urologic surgeons with reconstructive training.

Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and typical care settings, benchmark considerations relevant to hospital and ambulatory surgery environments, and policy-relevant notes on coverage and coding practice. The publication outlines common billing modifiers and service-line implications and highlights areas where documentation and coding specificity affect payment and quality measurement.

This summary is intended for national audiences including coding professionals, clinicians involved in pelvic reconstructive surgery, and payer policy staff seeking clarity on clinical indications, procedural context, and where coding specificity may influence administrative and reimbursement workflows. Data not available in the input is identified as such in the detailed sections.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare57311CPTurethrovaginal fistulafistula repairpelvic reconstructive surgerybulbocavernosus flapoperating roomambulatory surgery

Billing Code Overview

CPT code 57311 describes a surgical repair of a urethrovaginal fistula using the bulbocavernosus muscle to create flaps that cover the repair site. The procedure is a form of fistula repair in which the surgeon mobilizes local perineal musculature to reinforce and protect the closure of a urethral defect communicating with the vagina.

Service type: Surgical repair of urethrovaginal fistula using local muscle flap reconstruction
Typical site of service: Operating room or ambulatory surgery center, commonly performed by gynecologic surgeons or urologic surgeons with reconstructive expertise

Clinical & Coding Specifications

Clinical Context

A 38-year-old female presents with persistent urinary leakage and recurrent urinary tract infections following obstructed labor and vaginal delivery 2 years earlier. Physical examination reveals a vesicovaginal/urethrovaginal fistula with symptoms of continuous urinary dribbling and perineal discomfort. Prior conservative management including catheter drainage and local wound care failed. The urogynecology team schedules an operative repair under general anesthesia. The procedure involves a transvaginal approach with excision of fistulous tract, layered repair of the urethral and vaginal walls, and mobilization of bilateral bulbocavernosus muscle flaps to cover and reinforce the urethrovaginal repair (procedure coded as 57311). Intraoperative cystoscopy confirms fistula location and ureteral patency. A urethral catheter is left in place postoperatively for bladder drainage while the repair heals. Typical workflow includes preoperative evaluation (history, pelvic exam, urinalysis), anesthesia clearance, intraoperative cystoscopy, fistula repair with muscle flap, postoperative inpatient observation for 24–48 hours, catheter management, and follow-up visits for wound and continence assessment.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the repair requires substantially greater effort or complexity than typical, documented in operative report.

CPT 57240: Anterior Vaginal Wall Repair (Cystocele)

CPT-57285-PARAVAGINAL-DEFECT-REPAIR-VAGINAL-APPROACH

CPT 57285: Paravaginal Defect Repair, Vaginal Approach

CPT-57292-VAGINOPLASTY-WITH-GRAFT-CONSTRUCTION-ARTIFICIAL-VAGINA

CPT 57292: Vaginoplasty with Graft, Construction of Artificial Vagina

CPT-57250-RECTOCELE-REPAIR-POSTERIOR-VAGINAL-WALL-REPAIR

CPT 57250: Posterior Vaginal Wall Repair (Rectocele) with Perineal Repair

CPT-57284-PARAVAGINAL-DEFECT-REPAIR-ABDOMINAL-APPROACH

CPT 57284: Paravaginal Defect Repair, Abdominal Approach

CPT-57268-VAGINAL-REPAIR-SMALL-BOWEL-PROLAPSE

CPT 57268: Vaginal Repair for Small Bowel Prolapse

CPT-57280-ABDOMINAL-VAGINAL-VAULT-SUSPENSION

CPT 57280: Abdominal Vaginal Vault Suspension, Pelvic Reconstructive Surgery

CPT-57308-RECTOVAGINAL-FISTULA-REPAIR-PERINEAL-APPROACH

CPT 57308: Rectovaginal Fistula Repair via Perineal Approach

CPT-57305-ABDOMINAL-EXCISION-RECTOVAGINAL-FISTULA

CPT 57305: Abdominal Excision of Rectovaginal Fistula

CPT-57296-ABDOMINAL-REMOVAL-REVISION-PROSTHETIC-VAGINAL-GRAFT

CPT 57296: Abdominal Removal/Revision of Prosthetic Vaginal Graft

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Taxonomy Code	Specialty	Notes
`208100000X`	Female Pelvic Medicine & Reconstructive Surgery (Urogynecology)	Primary specialty performing urethrovaginal fistula repairs and muscle flap reconstructions.
`207V00000X`	Obstetrics & Gynecology	Gynecologic surgeons commonly perform transvaginal fistula repairs.
`363L00000X`	Urology	Urologists with pelvic reconstructive experience perform urethral and bladder fistula repairs.
`207L00000X`	Gynecologic Oncology	May be involved when fistula etiology relates to oncologic surgery and complex pelvic reconstruction is needed.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N82.1`	Vesicovaginal fistula	Directly indicates a fistulous connection between bladder and vagina; may coexist with urethrovaginal fistula requiring repair.
`N82.2`	Urethrovaginal fistula	Primary diagnosis indicating fistula between urethra and vagina—direct indication for `57311`.
`N39.0`	Urinary tract infection, site not specified	Frequently concurrent due to continuous leakage and bacterial colonization; managed pre- and postoperatively.
`N36.8`	Other specified disorders of urethra	Includes urethral injuries or defects associated with fistula formation.
`N99.89`	Other postprocedural disorders of genitourinary system	Used when fistula is a complication of prior pelvic surgery or procedure, relevant to surgical history and coding.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`52000`	Cystourethroscopy, with or without catheterization; diagnostic	Often performed preoperatively or intraoperatively to localize the fistula and assess bladder and ureteral orifices prior to repair.
`57288`	Revision (reconstruction) of enterocele and repair of vaginal vault prolapse	May be performed concurrently when pelvic floor defects are present and require reconstruction at time of fistula repair.
`57240`	Colporrhaphy, repair of cystocele	Performed when anterior vaginal wall defects coexist with urethrovaginal fistula and require simultaneous repair.
`51702`	Complex urethral dilation or urethral/trigonal repair procedures (urethral stent/catheter placement)	Used for perioperative urethral management, catheter placement or stenting when needed.
`49999`	Unlisted procedure, abdomen, peritoneum and omentum	Sometimes used for reportable but unlisted adjunct procedures not covered by standard codes when required in complex reconstruction

Note: These CPT codes were selected as commonly associated procedures in the perioperative care and reconstruction workflow for urethrovaginal fistula repair.

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