Wiki Need help on Hysterectomy procedure 58554 vs 58573 vs 58150

Create Wiki
H

hartford1

Contributor
Messages
11
Best answers
0
Good morning, I'm hoping to get advice on a GYN surgery. The provider wants to code a 58554 (LAVH) and the coder wants to code 57573 (TLH) and I'm thinking it might be a 58150 but would like some advice.

In his note.... he states the following - Due to the large uterus specimen that could not be removed through the narrow vagina the decision was made to extract the uterus from the abdomen through a minilaparotomy incision after closure of the vaginal cuff. We subsequently proceeded with an introduction of V-loc barbed suturing in a running fashion from right to left and left to right including this 2nd layer the bladder flap....Then we made a 6-cm transverse incision on the previous phannensteil scar.....Subsequently the uterus specimen identified and removed through the minilaparotomy without difficulty.

No where does he state removing the trocars either. I've attached a portion of the operative note.

Can I get some opinions on this.
Greatly appreciated
 

Attachments

  • image.png
    image.png
    57.1 KB · Views: 6
Hi, would need to see the rest of the op note.. Removing the uterus via the abdomen does not make it an abdominal hysterectomy. Basically, if they performed either an LAVH or TLH, the uterus can be removed EITHER vaginally or abdominally. For an LAVH, some ligments are cut via the vagina, ususally uterosac and/or cardinal. With a TLH, all ligments are cut via the scope. The mini lap could possibly get a mod 22 if those requirements were met.
 
Hi, thank you for your reply. I'm attaching the complete operative note, would love your opinion. there are 2 attachments.
 

Attachments

  • image.png
    image.png
    78.4 KB · Views: 5
  • image.png
    image.png
    57.1 KB · Views: 6
I read this as a TLH. It looks like all attachments, ligaments, arteries, veins, etc. were transected via laparoscope. As @Cmama12 stated, with LAVH, some of that dissection is done vaginally, which does not seem to be the situation here.
My personal opinion is there is enough additional work described for the mini-laparotomy to justify -22. As an education tool to your provider, you may want to suggest in the future an additional statement to make it clear this was more work than usual. In addition to what is already described, an addition statement makes it black and white. Something like:
"Spent an additional 42 minutes after the hysterectomy performing the required mini-laparotomy and closure to remove the enlarged uterus."
"Due to the enlarged uterus and additional work required to remove specimen, this surgery was substantially more technically difficult than usual."
 
Thank you for your reply. I was going with LAVH because of after the colpotomy - "The uterine artery was grasped, coagulated & cut. Excellent hemostatsis was noted. The coagulated uterine artery was then lateralized away from the vaginal cuff with synchroseal device. Similar dissection was done on the contralateral side. The site of the colpotomy was cleared away from the bladder, serosa and peritoneum and vessels. The colpotomy without difficulty. Ligation sites were reinspected and good hemostatsis was observed"

I think it's hard to tell when he is exactly doing the colpotomy? That's the issue I'm having. What are your thoughts?
Thanks.
 
hartford1 said:
Thank you for your reply. I was going with LAVH because of after the colpotomy - "The uterine artery was grasped, coagulated & cut. Excellent hemostatsis was noted. The coagulated uterine artery was then lateralized away from the vaginal cuff with synchroseal device. Similar dissection was done on the contralateral side. The site of the colpotomy was cleared away from the bladder, serosa and peritoneum and vessels. The colpotomy without difficulty. Ligation sites were reinspected and good hemostatsis was observed"

I think it's hard to tell when he is exactly doing the colpotomy? That's the issue I'm having. What are your thoughts?
Thanks.
Click to expand...
Hi, the uterine artery supplies blood to the uterus, it's not an attachment, so doesn't indicate an LAVH. Coagulating or skeletonizing the uterine artery is done with TLH I believe to prevent blood loss. I agree that his colpotomy description is not very clear but I would agree with @csperoni and still say TLH.
 
bgrasson said:
Yes it was an open procedure so 58150
Click to expand...
The surgery information posted was not an open procedure. The surgery was definitely performed laparoscopic. To me, the only possibilities are TLH vs LAVH. I interpret the surgery was done TLH.
 
hartford1 said:
Thank you for your reply. I was going with LAVH because of after the colpotomy - "The uterine artery was grasped, coagulated & cut. Excellent hemostatsis was noted. The coagulated uterine artery was then lateralized away from the vaginal cuff with synchroseal device. Similar dissection was done on the contralateral side. The site of the colpotomy was cleared away from the bladder, serosa and peritoneum and vessels. The colpotomy without difficulty. Ligation sites were reinspected and good hemostatsis was observed"

I think it's hard to tell when he is exactly doing the colpotomy? That's the issue I'm having. What are your thoughts?
Thanks.
Click to expand...
One technique used to surgically remove the uterus combines three steps, an initial laparoscopic stage, followed by a vaginal stage, and a final laparoscopic stage. The colpotomy is performed during the second step to deliver the uterus into the vagina. In this case he could not deliver the uterus that way although he tried. Hence, I would agree with csperoni and go with the TLH code as he did all the attachments were removed laparoscopically. With a TLH, the uterus does not have to be removed via the scope, but can be removed vaginally or sometimes with a minilap if it is large and they did not do morcellation.
 
You must log in or register to reply here.
Top