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CPT®
51920

CPT® Code 51920

Official Description

Closure of vesicouterine fistula;

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 51920 involves the surgical closure of a vesicouterine fistula, which is an abnormal connection between the bladder and the uterus. This condition can lead to significant complications, including urinary incontinence and recurrent urinary tract infections. The surgical approach begins with an incision in the lower abdomen, allowing the physician to inspect the abdominal cavity and pelvis thoroughly. During the procedure, the vesicouterine space is carefully dissected using both sharp and blunt dissection techniques to locate the fistulous tract. Once identified, the tract is excised, and the openings in both the bladder and uterus are meticulously closed. To ensure proper healing and prevent future complications, omentum, a fold of peritoneum, is interposed between the bladder and uterus. After the closure of the fistulous openings, the bladder is filled retrograde to confirm that the repair is watertight, ensuring no leakage occurs. Finally, the abdominal wall and skin are closed in a layered fashion, promoting optimal healing. This procedure is distinct from CPT® Code 51925, which involves the closure of a vesicouterine fistula in conjunction with a hysterectomy, indicating a more extensive surgical intervention.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The closure of a vesicouterine fistula, as described by CPT® Code 51920, is indicated in the following situations:

  • Vesicouterine Fistula The primary indication for this procedure is the presence of a vesicouterine fistula, which can result from various causes, including surgical complications, trauma, or obstetric injuries.
  • Urinary Incontinence Patients experiencing urinary incontinence due to the fistula may require this surgical intervention to restore normal bladder function.
  • Recurrent Urinary Tract Infections Individuals suffering from recurrent urinary tract infections as a result of the abnormal connection between the bladder and uterus may also be candidates for this procedure.

2. Procedure

The procedure for the closure of a vesicouterine fistula involves several critical steps, each designed to ensure the successful repair of the fistula and restoration of normal anatomy.

  • Step 1: Incision and Inspection The procedure begins with a surgical incision in the lower abdomen, allowing the physician to gain access to the abdominal cavity. This step is crucial for visualizing the internal structures and assessing the extent of the fistula.
  • Step 2: Dissection of the Vesicouterine Space Once the abdomen is opened, the vesicouterine space is dissected using both sharp and blunt dissection techniques. This careful dissection is necessary to locate the fistulous tract accurately.
  • Step 3: Excision of the Fistulous Tract After identifying the fistulous tract, the surgeon excises it. This step is vital to remove the abnormal connection between the bladder and uterus, which is the source of the patient's symptoms.
  • Step 4: Closure of the Bladder Opening Following the excision, the opening in the bladder is closed. This closure must be performed meticulously to ensure that the bladder can function normally post-surgery.
  • Step 5: Closure of the Uterine Opening The next step involves closing the opening in the uterus. To prevent future complications, omentum is interposed between the bladder and uterus during this closure.
  • Step 6: Verification of Bladder Repair To confirm the integrity of the bladder repair, the bladder is filled in a retrograde fashion. This step is essential to verify that the closure is watertight and that there is no leakage.
  • Step 7: Closure of the Abdominal Wall Finally, the abdominal wall and skin are closed in a layered fashion. This layered closure promotes optimal healing and reduces the risk of complications at the surgical site.

3. Post-Procedure

After the closure of the vesicouterine fistula, patients can expect a recovery period that may involve monitoring for any signs of complications, such as infection or leakage from the bladder. Post-operative care typically includes pain management, instructions for activity restrictions, and follow-up appointments to assess healing. Patients may also be advised on fluid intake and urinary habits to support recovery. It is essential for healthcare providers to provide thorough post-operative instructions to ensure a successful recovery and minimize the risk of recurrence of the fistula.
Short Descr CLOSE BLADDER-UTERUS FISTULA
Medium Descr CLOSURE VESICOUTERINE FISTULA
Long Descr Closure of vesicouterine fistula;
Status Code Active Code
Global Days 090 - Major Surgery
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 2 - Payment restriction for assistants at surgery does not apply to this procedure...
Co-Surgeons (62) 1 - Co-surgeons could be paid, though supporting documentation is required...
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Inpatient Procedures, not paid under OPPS
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P1G - Major procedure - Other
MUE 1
CCS Clinical Classification 112 - Other OR therapeutic procedures of urinary tract
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
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2010-01-01 Changed Code description changed.
Pre-1990 Added Code added.
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