Wiki Open Vs Laparoscopic Hysterectomy

[ahenning]

A provider did a supracervical hysterectomy where he preformed a majority of the procedure laparoscopically. He mentions in his op report that “as the uterus would need to be removed through an open incision, a small transverse skin incision was created suprapubically.” The note then describes the incision, mentioning the fat and fascia being divided, the rectus muscles separated, and the uterus removed through the abdominal incision. The insicion is closed and a second laparoscopic procedure is performed for a sacral colpopexy.

The physician feels as if the 58544- lap supracervical hysterectomy for uterus over 250 g is most appropriate as ACOG states the uterus is removed through the abdomen. However through my findings for the 58544 is removed in peices through the trocar sites, not a separate incision.

This was coded as an open hysterectomy due to the uterus being removed through an open incision.

Given the information, is the most accurate code 58180- supracervical abdominal hysterectomy, with or without tubes and/or ovaries?

 

[csperoni]

I unfortunately cannot locate specific references for this, but this was a laparoscopic supracervical hysterectomy. If you are seeing guidance about the uterus being morcellated and removed through the trocar sites, this is outdated and no longer takes place. Morcellation is no longer done due to the rare instance the patient had an underlying unsuspected malignancy, this dissipates the cancer cells throughout the abdomen. Just as if you perform a laparoscopic total hysterectomy and remove the specimen through the vagina, you are not doing a vaginal hysterectomy.

If it was a laparoscopic procedure converted to an open, you would bill the open. As I am interpreting your situation, the entire procedure was done laparoscopically and then the physician created a larger opening in the abdomen simply to remove the large uterus. My vote is 58544.

 

[blckjnpr]

I would agree with Christine on laparoscopic 58544. We usually code laparoscopic hysterectomies that require an extension of an incision for removal with a 22 modifier for the extra work of the 'mini lap'. I do have one surgeon that sticks to the open rule for this scenario and codes as an open hysterectomy instead. I think either way could be considered correct, but with your scenario including continuing on to do another laparoscopic procedure, i would stick with the lap codes.