How To Use CPT Code 57307

CPT 57307 describes the closure of a rectovaginal fistula using an abdominal approach, with the addition of a colostomy. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 57307?

CPT 57307 can be used to describe the closure of a rectovaginal fistula using an abdominal approach, along with the creation of a colostomy. This code is used when the physician excises the fistula and brings one end of the colon out of the body to create an artificial opening in the abdominal wall for stool excretion.

2. Official Description

The official description of CPT code 57307 is: ‘Closure of rectovaginal fistula; abdominal approach, with concomitant colostomy.’

3. Procedure

1. The physician administers anesthesia and positions the patient supine.
2. A skin incision is made in the lower abdomen, and the peritoneal cavity is entered.
3. The physician explores the abdominal cavity and packs the bowel away from the operative site.
4. The sigmoid colon is released from the surrounding tissue.
5. The physician enters the rectovaginal fascia and dissects the vagina from the rectum.
6. The fistula is identified and excised.
7. The defect created by removing the fistula is closed using staples or sutures.
8. The vaginal incision is closed.
9. A colostomy is created to divert feces outside the body.
10. A loop of large bowel close to the fistula repair site is isolated, and a separate skin incision is made in the abdominal wall.
11. The loop of bowel is brought out of the body through this incision and sutured in place.
12. An opening is made into the loop of colon to allow feces to exit the body.
13. A drain is inserted and secured to drain into the vaginal canal or outside the body through the abdominal wall.
14. The bowel that was packed away is moved back into the pelvis, and the abdominal incision is closed with sutures.

4. Qualifying circumstances

Patients eligible for CPT 57307 are those with a rectovaginal fistula, which is an abnormal passage between the rectum and the vagina. This condition can be caused by obstetric injuries, incomplete healing of an episiotomy, rectocele repair, radiation therapy, or uterine cancer. The procedure is performed using an abdominal approach, and a colostomy is created to divert feces outside the body.

5. When to use CPT code 57307

CPT code 57307 should be used when a physician performs the closure of a rectovaginal fistula using an abdominal approach, with the addition of a colostomy. This code should not be used for procedures performed through other approaches or without the creation of a colostomy.

6. Documentation requirements

To support a claim for CPT 57307, the physician must document the following information:

• Patient’s diagnosis of a rectovaginal fistula
• Description of the procedure performed, including the closure of the fistula and the creation of a colostomy
• Date of the procedure
• Details of the surgical approach used
• Any additional procedures performed during the same operative session
• Any complications or unexpected findings
• Signature of the performing physician

7. Billing guidelines

When billing for CPT 57307, ensure that the procedure is performed using an abdominal approach and includes the creation of a colostomy. This code should not be reported with other codes unless additional procedures were performed during the same operative session. Follow the appropriate coding guidelines and modifiers for accurate billing.

8. Historical information

CPT 57307 was added to the Current Procedural Terminology system on January 1, 1990. In 2017, it was added to the Inpatient Only (IPO) list for Medicare billing purposes.

9. Examples

1. A physician performing the closure of a rectovaginal fistula using an abdominal approach, with the creation of a colostomy for a patient with a history of obstetric injury.
2. A surgeon excising a rectovaginal fistula and creating a colostomy for a patient who underwent rectocele repair.
3. A physician performing the closure of a rectovaginal fistula using an abdominal approach, with the addition of a colostomy for a patient undergoing treatment for uterine cancer.
4. A surgeon performing the closure of a rectovaginal fistula using an abdominal approach, with the creation of a colostomy for a patient who experienced incomplete healing of an episiotomy.
5. A physician excising a rectovaginal fistula and creating a colostomy for a patient who underwent radiation therapy for pelvic malignancy.
6. A surgeon performing the closure of a rectovaginal fistula using an abdominal approach, with the addition of a colostomy for a patient with a history of multiple obstetric injuries.
7. A physician excising a rectovaginal fistula and creating a colostomy for a patient who underwent previous repair of a rectovaginal fistula.
8. A surgeon performing the closure of a rectovaginal fistula using an abdominal approach, with the creation of a colostomy for a patient with a history of recurrent rectovaginal fistulas.
9. A physician excising a rectovaginal fistula and creating a colostomy for a patient who underwent previous treatment for uterine cancer.