Congenital fistula of rectum and anus

This code describes a birth defect where an abnormal connection (fistula) exists between the rectum and/or anus and another structure, typically the skin, perineum, or vagina (excluding rectovaginal or urethrorectal). This condition is present from birth and results in the passage of stool through an anomalous opening.

Use this code when documentation clearly indicates a congenital fistula involving the rectum and/or anus, without an associated absence, atresia, or stenosis of the anus or rectum. This code is appropriate for cases such as an anocutaneous fistula or a rectoperineal fistula identified at birth or shortly thereafter.

• Carefully review documentation to differentiate between congenital and acquired fistulas; this code is strictly for congenital etiologies.
• Ensure the fistula does not involve absence, atresia, or stenosis of the anus or rectum, as those conditions have specific exclusion codes.
• Confirm the fistula is not rectovaginal or urethrorectal, as these are classified to different Q codes.