Question Hysterectomy Op-Report 58571 vs. 58552

domonique

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Hi, I need help coding a hysterectomy but not sure if I should bill 58571 vs 58552. I was sure it was 58552 but now I'm thinking it's 58571. Thanks in advance!

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csperoni

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Above is an excellent article from ACOG explaining total laparoscopic vs laparoscopic assisted hysterectomy.
In almost all situations, the specimens are removed through the vagina, as a morcellator is rarely (if ever) used during hysterectomies anymore. I haven't seen it in years. Simply removing the specimen per vagina does not necessarily make it laparoscopic assisted vaginal hysterectomy. It matters how the ligaments and uterus/cervix are detached. In your op note, it appears the colpotomy was done, and the uterosacral ligaments were transected through the vagina, not through the laparoscopic ports. That would lead me to 58552.
I would note with 2 large fibroids, I would await pathology to see if you are >250gms and possibly 58554.
 

Cmama12

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Hi, for my two cents, I would query this as it's not entirely clear. I lean toward 58571 because they are talking about going around the cup and they don't mention placing a speculum or grasping the cervix as in this LAVH example:

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csperoni

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Hi, for my two cents, I would query this as it's not entirely clear. I lean toward 58571 because they are talking about going around the cup and they don't mention placing a speculum or grasping the cervix as in this LAVH example:

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I agree it certainly wouldn't hurt to query, but based on the way my providers document, I'm reading this that uterosacral ligaments were detached vaginally, and cuff was sutured vaginally. That leads me to 58552. If I am reading this wrong and all ligaments were detached via laparoscope, then 58571.
 
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