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 | Tissues are removed through the abdomen or vagina | |
| 58572 | > 250 grams | No | Yes | Tissues are removed through the abdomen or vagina | |
| 58573 | > 250 grams | Yes | Yes | 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 |