Persistent postprocedural fistula, initial encounter

This code signifies a post-surgical or post-procedural abnormal communication between two organs or an organ and the body surface that has not healed and continues to drain or persist beyond the expected recovery period. It indicates a chronic or ongoing fistula resulting from a previous medical intervention.

Use this code when documenting a patient presenting with a fistula that developed after a surgical procedure, biopsy, or other invasive medical intervention, and the fistula has been present for an extended duration, indicating a persistent rather than acute complication. This applies to initial encounters for the management of such a persistent fistula.

• Ensure the documentation clearly states the fistula is a sequela of a prior procedure and has been persistent.
• Verify this is the initial encounter for this specific persistent fistula; subsequent encounters would use the appropriate seventh character.
• Code the underlying condition or reason for the original procedure if relevant and still being treated.