Wiki Laparoscopic Radical Hysterectomy 58548

[Thensle2@hfhs.org]

Is it appropriate to code CPT 58548 when the parametrium isn't excised enbloc with the uterus? There is no mention of this being a requirement in the Ob/Gyn Companion or the CDR, however much of the literature online states that the parametrium is excised enbloc with the uterus during a radical hysterectomy. I have seen these coded separately with a simple hysterectomy code and a lymphnode code, ie. 58571 with 38572, however I'm not sure that this is the preferred way. Any feedback would be greatly appreciated. Thanks so much.

 

[blckjnpr]

I think for a hysterectomy to be considered radical, extra tissue beyond a simple hysterectomy has to be removed - i.e. parametrial tissue and a portion of the upper vagina. If it isn't documented, I would use 58571 with 38572. Some of my providers disagree and say a radical code can be used so long as lymphadenectomy is performed. As you noted, lots of literature supports the removal of the parametrium/upper vagina for a radical, but it is not stated that way in coding books, so it is confusing!!