Coding Laparoscopic Hysterectomy Procedures

ACOG frequently receives requests for an explanation of the differences between coding for total laparoscopic hysterectomy (TLH) and laparoscopy with vaginal hysterectomy (LAVH).  As a result, we are re-posting our previous article on this topic.

In CPT 2008, the American Medical Association (AMA) published the total laparoscopic hysterectomy (TLH) set of codes (58570-58573).  This, in addition to the laparoscopic radical hysterectomy with pelvic lymphadenectomy code (58548), is the third set of CPT codes addressing the laparoscopic approach to hysterectomy.  The other CPT code sets are the laparoscopy with vaginal hysterectomy (LAVH) (58550-58554) and laparoscopic supracervical hysterectomy (LSH) (58541–58544) code sets.  Each of the code sets are subdivided into uteri less than or greater than 250 grams and with or without removal of tube(s) and/or ovary(s).

TLH includes laparoscopically detaching the entire uterine cervix and body from the surrounding supporting structures and suturing the vaginal cuff.  It includes bivalving, coring, or morcellating the excised tissues, as required. The uterus is then removed through the vagina or abdomen.

LAVH includes laparoscopically detaching the uterine body from the surrounding upper supporting structures.  The vaginal portion of the procedure is then performed.  The vaginal apex is entered and the cervix and uterus are detached from the remaining supporting structures.  The uterus is then removed through the vagina.   

LSH includes laparoscopically detaching the body of the uterus down to the uterine arteries.  The uterine body is then separated from the cervix, hemostasis of the cervical stump is achieved, and the endocervical canal is coagulated.  The uterine body is then abdominally removed by bivalving, coring, or morcellating, as required.

 
ACOG Coding staff has developed laparoscopic hysterectomy charts that summarize the differences in these procedures. The information within the charts is intended to be used as a guide for correct coding and should not be used without a current CPT book.

Total Laparoscopic Hysterectomy (TLH) (Effective Jan. 1, 2008)

 CPT Codes Uterine
Size
Tubes and/or
ovaries
Removal
of cervix
Approach to
removal
Route of removal
58570 ≤ 250 grams No Yes Detachment of
entire uterine
cervix and body
via the laparoscope
Tissues are
removed through
the abdomen or vagina
 
58571 ≤ 250 grams Yes Yes Detachment of
entire uterine
cervix and body
via the laparoscope
Tissues are
removed through
the abdomen or
vagina
 
58572 > 250 grams No Yes Detachment of
entire uterine
cervix and body
via the laparoscope
Tissues are
removed through
the abdomen or
vagina
 
58573 > 250 grams Yes Yes Detachment of
entire uterine
cervix and body
via the laparoscope
Tissues are
removed through
the abdomen or
vagina

Laparoscopic Assisted Vaginal Hysterectomy (LAVH)

 CPT Codes Uterine
Size
Tubes and/or
ovaries
Removal
of cervix
Approach to
removal
Route of removal
58550 ≤ 250 grams No Yes Detachment of
entire uterine
cervix and body
via the laparoscope
and vagina
 
Tissues are
removed through
the vagina
58552 ≤ 250 grams Yes Yes Detachment of
entire uterine
cervix and body
via the laparoscope
and vagina
 
Tissues are removed through the vagina 
58553 > 250 grams No Yes Detachment of
entire uterine
cervix and body
via the laparoscope
and vagina
 
Tissues are removed through the vagina 
58554 > 250 grams Yes Yes Detachment of
entire uterine
cervix and body
via the laparoscope
and vagina
Tissues are removed through the vagina

Laparoscopic Supracervical Hysterectomy (LSH)

 CPT Codes Uterine
Size
Tubes and/or
ovaries
Removal
of cervix
Approach to
removal
Route of removal
58541 ≤ 250 grams No No Detachment of
uterus from the
cervix and
surrounding tissue
laparoscopically
 
Tissues are removed through the abdomen 
58542 ≤ 250 grams Yes No Detachment of
uterus from the
cervix and
surrounding tissue
laparoscopically
 
Tissues are removed through the abdomen
58543 > 250 grams No No Detachment of
uterus from the
cervix and
surrounding tissue
laparoscopically
 
Tissues are removed through the abdomen
58544 > 250 grams Yes No Detachment of
uterus from the
cervix and
surrounding tissue
laparoscopically
Tissues are removed through the abdomen

American College of Obstetricians & Gynecologists (ACOG)    
CPT Only ©2007 American Medical Association. All Rights Reserved.

Contact:

Donna Tyler
Manager, Coding Education
dtyler@acog.org

Keisha Sutton
Coding Specialist
ksutton@acog.org