Urology Coding Alert

Question: My doctor wrote “excision of vesicocutaneous fistula” in a patient’s chart, and I’m unsure which code to use. What is the best code to report this procedure?


New York Subscriber


Answer: You should report 51880 (Closure of cystostomy [separate procedure]) for the procedure. Most vesicocutaneous fistulae result from a failure of a suprapubic tract to close completely after the removal of a temporary suprapubic cystostomy tube. This means you should use 51880 because it is the most accurate code for closure of this type of fistula.

Although reading the operative report is always best to be sure of the correct codes, in this case the assumption is that after the physician performed the excision of the tract, he then did a plastic repair of the bladder to close the defect. As with most excisions and closures of fistulae, the urologist removed the tract, and therefore the repair of the defect becomes the primary procedure.

Occasionally, you may notice your physician notes a draining vesicocutaneous fistula secondary to a congenital urachal sinus tract (753.7, Anomalies of urachus, fistula). In this case, report code 51500 (Excision of urachal cyst or sinus, with or without umbilical hernia repair) for the excision and closure of this type of fistula.