Wiki Radical Hysterecomy vs Hysterecomy and Pelvic Lymphadenecomy/Para Aortic node Samp

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Leighannreese

Leighannreese

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Hello,

I code for Gyn/Onc surgeons and I am wondering if anyone knows the required documentation in order to report 58210/58548 vs 58150/58572 with 38572.
Is it simply the total bilateral pelvic lymphadenectomy and para aortic node sampling done during the hysterectomy that makes the procedure radical or do more structures need to be removed than a normal TAHBSO as well as the bilateral pelvic lymphadenectomy and para aortic node sampling?

This is confusing me on what documentation needs to be there in order to report a radical hysterectomy.

Any help is greatly appreciated!!!

Thank you :)
 
This does get tricky, especially as the advice has changed over the years.
1) Radical means removal of additional tissue - parametrium (tissue surrounding uterus), upper portion of the vagina, etc. It helps if your physician is good at documenting whenever additional tissue is removed.

2) There was not always a code for radical laparoscopic (or even total laparoscopic) hysterectomy. Once you go back more than 10 years, basically no one was doing laparoscopic hysterectomies for cancer patients. At that time, the advice from ACOG and SGO was for TAH, BSO, PPALND to use 58210. It was considered incorrect to bill 58150 along with 38562 for lymph nodes was unbundling and not appropriate. There was even wording in the CPT book to indicate this.

3) In the past few years, with many more physicians doing laparoscopic procedures thanks to daVinci, 58570-58573 and 58548 came along. The coding advice with these new codes was to bill 58570-58573 ALONG WITH 38572 unless it was truly a RADICAL hysterectomy.
Somewhere around this time, the advice for 58210 changed and it no longer specifies to bill this code even if the open TAH was not radical.

Summary:
LAPAROSCOPIC - it is very cut & dried. If it was radical (removal of additional tissue), use 58548. If not, use 58570-58573 and 38572.
OPEN - The issue we are left with is that while it is no longer specified to use 58210 for TAH, BSO & PPALND, there is not really a better option to get proper payment as 38562 has the "separate procedure" designation. Most offices will likely use 58210 even if not radical, since that was historically the guidance issued.

SGO has a great resource (but a little outdated for some procedures) of previously asked coding Q&A.
https://www.sgo.org/wp-content/uploads/2016/07/Coding-Q-A-2016.docx
Specifically, questions 30, 33, 73 & 98 address this issue.

I hope this sheds at least a little more light on a grey area. :)
 
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