Ob-Gyn Coding Alert

Don’t miss common add-ons during hysterectomy procedures.

With approximately 600,000 hysterectomies performed each year in the U.S., coding these high-volume procedures accurately is critical — not just for compliance, but for optimizing reimbursement. To code a hysterectomy correctly, you need to consider these key factors: the approach, the size/weight of the uterus removal, and extent of uterus removed.

But that’s not all: Ob-gyns often perform additional procedures, such as oophorectomy, salpingectomy, or pelvic repairs, at the same time. Capturing those combo procedures requires sharp attention to operative reports and precise documentation.

In this guide, we’ll break down exactly what to look for, what to code, and how to ensure no dollar — or detail — is left behind.

First Things First: What’s Your Ob-Gyn’s Approach?

When it comes to coding a hysterectomy, the very first thing you need to pin down is how the ob-gyn performed the procedure. The surgical approach is your starting point — it tells you which CPT^® code series to dig into.

If the hysterectomy was done open (i.e., abdominal), check out the code range 58150-58240. If cancer was the reason for the procedure, shift to 58951-58956.

But if it was done vaginally, you’ll want to look in the 58260-58294 range.

Now, if it was laparoscopic, you’ve got more variety:

• Laparoscopic-assisted vaginal hysterectomy (LAVH)? That’s 58550–58554.
• Supracervical laparoscopic hysterectomy? Look to 58541–58544.
• Total laparoscopic hysterectomy? You’re in 58570–58575 territory.

Why this matters: The approach dramatically affects reimbursement. Laparotomy (open) procedures usually come with higher relative value units (RVUs) than laparoscopic ones, even if the workload is similar, explains coding expert Melanie Witt, RN, MA, an independent coding expert based in Guadalupita, New Mexico.

Next, How Heavy Was That Uterus?

Next, it’s all about the uterus size. CPT^® codes divide procedures based on whether the uterus weighed 250 grams or less or more than 250 grams. This info usually comes from the pathology report, so make sure you have it.

For a uterus 250 grams or less, you will look to these codes:

• Vaginal hysterectomy: Use 58260-58270
• Laparoscopic: Use 58550-58552 or 58570-58571
• Supracervical laparoscopic: Use 58541–58542

For a uterus over 250 grams:

• Vaginal approach: Use 58290-58294
• Laparoscopic: Use 58553-58554 or 58572-58573
• Supracervical laparoscopic: Use 58543-58544

Pro tip: Don’t include the weight of separately removed fibroids in the uterus weight. If fibroids are taken out as a separate specimen, they don’t count toward the uterine weight for coding purposes.

How Much Did Your Ob-Gyn Actually Remove?

Not all hysterectomies are created equal. Was it total (uterus and cervix) or subtotal/supracervical (just the uterus, leaving the cervix)?

If the ob-gyn performed a subtotal open hysterectomy, your code is likely 58180 (Supracervical abdominal hysterectomy (subtotal hysterectomy), with or without removal of tube(s), with or without removal of ovary(s)) — this covers just the uterus, with or without tubes and ovaries.

Make sure your code accurately reflects the extent of the procedure.

Don’t Jump the Gun on Additional Procedures

Here’s where things can get tricky. Just because the tubes or ovaries were removed doesn’t mean you automatically get to code them separately. If the CPT^® code already includes “with or without removal of tubes and/or ovaries,” you can’t bill extra for them.

Same goes for fibroid removal during a hysterectomy. If the uterus goes, so do the fibroids — no separate code allowed.

Watch out: If you code extra when you shouldn’t, this can trigger denials or audits.

Let’s Put it all Together: Quick Coding Challenge

Scenario: Your ob-gyn performs a vaginal hysterectomy on a patient. The uterus weighs under 250 grams. Tubes and ovaries are not removed.

Here’s how to break it down:

• Approach: Vaginal (58260-58294)
• Uterus weight: ≤250 grams (58260-58270)
• Extent: The ob-gyn did not remove any tubes or ovaries, so 58260 (Vaginal hysterectomy, for uterus 250 g or less) is the correct code.

Had there been an additional procedure — like an enterocele repair or colpourethrocystopexy — you’d need to code for that as well, and possibly shift your primary hysterectomy code.

Don’t Overlook This Additional Part of the Story: Combination Claims

As an ob-gyn coder, you know that a hysterectomy is rarely just a hysterectomy. Surgeons often tackle multiple pelvic issues in one session, and your job is to code each element accurately. From stress incontinence to cancer staging, understanding when and how to capture combination procedures can make or break your claim. Let’s walk through the scenarios where you’ve got more than a uterus coming out — and how to handle it.

Hysterectomy + Stress Incontinence Fix? Know These Fixation Terms

If your ob-gyn performs a bladder or urethral suspension during the hysterectomy, listen for terms like Marshall-Marchetti-Krantz, Burch, or Pereyra. These aren’t just surgical slang — they’re your signal to pick the right combo code:

• Abdominal approach? Go with 58152 (Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s); with colpo-urethrocystopexy (eg, Marshall-Marchetti-Krantz, Burch)).
• Vaginal approach? You’re looking at 58267 (Vaginal hysterectomy, for uterus 250 g or less; with colpo-urethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type) with or without endoscopic control).

Pro tip: If your surgeon mentions “bladder lift” or “urethral support,” dig into the op note for those buzzwords — they’re your coding green light.

Hysterectomy + Vaginectomy? Different Game, Different Codes

When the ob-gyn removes part or all the vagina during a hysterectomy (often for malignancy), you’re in more advanced coding territory:

• Open procedure with cancer staging: Think 58200 (Total abdominal hysterectomy, including partial vaginectomy, with para-aortic and pelvic lymph node sampling, with or without removal of tube(s), with or without removal of ovary(s)) — this includes partial vaginectomy and lymph node sampling.
• Radical open: You’ll report 58210 (Radical abdominal hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy), with or without removal of tube(s), with or without removal of ovary(s)).
• Laparoscopic radical: Use 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).
• Vaginal route: Consider:
  • 58275 (Vaginal hysterectomy, with total or partial vaginectomy) for total/partial vaginectomy,
  • 58280 (… with repair of enterocele) if there’s also an enterocele repair, or
  • 58285 (Vaginal hysterectomy, radical (Schauta type operation)) for a Schauta-type radical vaginal hysterectomy.

Remember: Radical hysterectomies typically involve parametrial tissue and removal of the upper third of the vagina — make sure that’s documented before selecting these codes.

Hysterectomy + Lymph Node Sampling? Time to Get Specific

When cancer’s in the picture, lymph node sampling is often part of the plan — but not every approach qualifies:

• Modified radical abdominal hysterectomy with partial vaginectomy and node sampling? That’s 58200.
• Full bilateral pelvic and para-aortic lymphadenectomy via open surgery? Code 58210.
• Laparoscopic version? That’s 58548.

Miss the lymph node biopsy, and you’re undercoding a major cancer staging component.

Cancer Cases? These 4 Codes Are Power Moves

If the primary issue is ovarian or uterine cancer, and the procedure involves full staging and debulking, your go-to codes shift dramatically:

• 58951 (Resection (initial) of ovarian, tubal or primary peritoneal malignancy with bilateral salpingo-oophorectomy and omentectomy; with total abdominal hysterectomy, pelvic and limited para-aortic lymphadenectomy) includes BSO, omentectomy, TAH, pelvic + limited para-aortic lymphadenectomy
• 58953/58954 (Bilateral salpingo-oophorectomy with omentectomy, total abdominal hysterectomy and radical dissection for debulking …) adds radical dissection, with or without extended lymph node work
• 58956 (Bilateral salpingo-oophorectomy with total omentectomy, total abdominal hysterectomy for malignancy) is for malignancy, with full omentectomy and TAH

Coding tip: Always double-check the pathology and operative notes to verify what’s included — these codes are precise and powerful, but easy to misuse.

Don’t Fumble Enterocele Repairs

Enterocele repairs often show up during hysterectomies, especially via vaginal approach. Luckily, there are combo codes that cover both services:

• 58263 (Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s), with repair of enterocele) is for a vaginal hysterectomy (≤250g) + removal of tubes/ovaries + enterocele repair
• 58270 (… with repair of enterocele) is for a vaginal hysterectomy (≤250g) + enterocele repair
• 58280 (Vaginal hysterectomy, with total or partial vaginectomy; with repair of enterocele) is for a vaginal hysterectomy + partial/total vaginectomy + enterocele repair
• 58292/58294 (Vaginal hysterectomy, for uterus greater than 250 g …) is for larger uteri (>250g) with repairs

No combination code exists for vaginal hysterectomy with abdominal enterocele repair.

Try Your Hand at this Scenario

Scenario: Your ob-gyn performs a vaginal hysterectomy (≤250g uterus), enterocele repair, and a colpourethrocystopexy for stress incontinence.

You’ve got two valid coding paths, depending on how the procedures are documented:

Option 1:

• 58270: Vaginal hysterectomy + enterocele repair
• 51840 (Anterior vesicourethropexy, or urethropexy (eg, Marshall-Marchetti-Krantz, Burch); simple): Simple colpourethrocystopexy, e.g., Marshall-Marchetti-Krantz

Total RVUs: 26.92 (58270) + 20.90 (51840) = 47.82

Option 2:

• 58267: Vaginal hysterectomy + colpourethrocystopexy
• 57268 (Repair of enterocele, vaginal approach (separate procedure)): Separate enterocele repair

Total RVUs: 32.16 (58267) + 15.30 (57268) = 47.46

Best choice? Option 1 gives you slightly higher RVUs, and National Correct Coding Initiative (NCCI) edits don’t block this combo. As long as your ob-gyn’s documentation supports both, report option 1.

Bottom Line for Coders

These combo procedures may be a single surgery for the surgeon, but they’re multiple layers of complexity for you. Know your anatomy, spot your surgical cues, and use those CPT^® descriptors like a checklist. When in doubt, scan that op note like a detective — it could mean the difference between a denied claim and a clean, high-value one.

Suzanne Burmeister, BA, MPhil, Medical Writer and Editor