CPT Assistant, August 2021, Volume 31, Issue 8, page 8
There has been confusion about the difference between a total laparoscopic hysterectomy and a laparoscopy with vaginal hysterectomy, as well as the documentation requirements and the appropriate Current Procedural Terminology (CPT®) codes to report for these procedures. The primary difference between the procedures in this family of codes is the method of detaching the structures rather than the route of structure extraction. This article will provide clarification for correct reporting.
Laparoscopy/Hysteroscopy
Laparoscopic hysterectomy codes include total laparoscopic hysterectomy codes (58570-58573), laparoscopy with vaginal hysterectomy codes (58550-58554), and laparoscopic supracervical hysterectomy codes (58541-58544). Each family of codes are subdivided into uteri 250 grams or less and greater than 250 grams and with or without removal of tube(s) and/or ovary(s). These codes, in addition to codes 58548 and 58575, are the entire range of codes that address the laparoscopic approach to hysterectomy. The primary difference between the procedures in this family of codes is the method of detaching the structures rather than the route of structure extraction.
Total laparoscopic hysterectomy includes laparoscopically detaching the entire uterine cervix and body from the surrounding supporting structures and suturing the vaginal cuff. It includes laparoscopically bivalving, coring, or morcellating the excised tissues, as required. The uterus is removed through the vagina or abdomen. Codes 58548, Laparoscopy, surgical, with radical hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy), with removal of tube(s) and ovary(s), if performed, and 58575, Laparoscopy, surgical, total hysterectomy for resection of malignancy (tumor debulking), with omentectomy including salpingo-oophorectomy, unilateral or bilateral, when performed, represent procedures also performed via a total laparoscopic hysterectomy approach; however, these procedures are performed primarily for excision of malignancy.
Laparoscopy with vaginal hysterectomy includes laparoscopically detaching the uterine body from the surrounding upper supporting structures. The vaginal portion of the procedure is performed. The vaginal apex is entered. Both the cervix and uterus are detached from the remaining supporting structures. The uterus is removed through the vagina.
Laparoscopic supracervical hysterectomy includes laparoscopically detaching the body of the uterus down to the uterine arteries. The uterine body is separated from the cervix, hemostasis of the cervical stump is achieved, and the endocervical canal is coagulated. The uterine body is laparoscopically removed through the abdomen by bivalving, coring, or morcellating, as required.
Table 1 summarizes the differences between each of these procedures. The information in this table should be used as a guide together with the current version of the CPT code set.
Table 1. Summary of Laparoscopic Hysterectomy Procedures and Codes
CPT Codes | Uterine Size | Tube(s) | Removal of Cervix | Method of Detachment | Method of Extraction | |
|---|---|---|---|---|---|---|
Total Laparoscopic Hysterectomy | ||||||
58570 | ≤ 250 grams | No | Yes | Entire uterine cervix and body via laparoscope | Abdomen or Vagina | |
58571 | ≤ 250 grams | Yes | Yes | Entire uterine cervix and body via laparoscope | Abdomen or Vagina | |
58572 | > 250 grams | No | Yes | Entire uterine cervix and body via laparoscope | Abdomen or Vagina | |
58573 | > 250 grams | Yes | Yes | Entire uterine cervix and body via laparoscope | Abdomen or Vagina | |
Laparoscopic Hysterectomy for Malignancy | ||||||
58548 | unspecified | Yes | Yes | Entire uterine cervix and body via laparoscope with para-aortic lymph node sampling; may also include excision of the vagina | Abdomen or Vagina | |
58575 | unspecified | Yes | Yes | Entire uterine cervix and body via laparoscope; also includes tumor debulking and omentectomy | Abdomen | |
Laparoscopy With Vaginal Hysterectomy | ||||||
58550 | ≤ 250 grams | No | Yes | Upper uterine body via the laparoscope and cervix or lower uterine body through the vagina | Vagina | |
58552 | ≤ 250 grams | Yes | Yes | Upper uterine body via the laparoscope and cervix or lower uterine body through the vagina | Vagina | |
58553 | > 250 grams | No | Yes | Upper uterine body via the laparoscope and cervix or lower uterine body through the vagina | Vagina | |
58554 | > 250 grams | Yes | Yes | Upper uterine body via the laparoscope and cervix or lower uterine body through the vagina | Vagina | |
Laparoscopic Supracervical Hysterectomy | ||||||
58541 | ≤ 250 grams | No | No | Uterus from the cervix and surrounding tissue laparoscopically | Abdomen | |
58542 | ≤ 250 grams | Yes | No | Uterus from the cervix and surrounding tissue laparoscopically | Abdomen | |
58543 | > 250 grams | No | No | Uterus from the cervix and surrounding tissue laparoscopically | Abdomen | |
58544 | > 250 grams | Yes | No | Uterus from the cervix and surrounding tissue laparoscopically | Abdomen | |
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