CPT 58571 is used for a total laparoscopic hysterectomy, which removes the uterus and related structures through small incisions in the abdomen.
What Is CPT Code 58571?
CPT code 58571 describes a laparoscopic surgery procedure called a total hysterectomy, which involves the removal of the uterus, cervix, and fallopian tubes through small incisions in the abdomen, with or without the removal of the ovaries.
This procedure is typically performed using laparoscopic instruments and may involve a laparoscope, a specialized medical device that allows the surgeon to view the inside of the abdomen, and trocars, which are used to insert instruments into the body through small incisions.
The procedure may also involve using a robotic surgical system, allowing the surgeon to control the laparoscopic instruments remotely.
This procedure is performed under general anesthesia. It may involve using a combination uterine manipulator-colpotomizer device, which helps the surgeon move the uterus and guide the incisions to remove it.
The procedure may also involve ligating or tying various ligaments and blood vessels, as well as the incision and suture closure of the vaginal cuff.
What Is CPT Code 58571
The CPT book describes CPT code 58571 as: “Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; with the removal of tube(s) and/or ovary(s).”
First, the provider places the patient in the dorsal lithotomy position. He then preps and drapes the abdomen and administers a general anesthetic.
The provider enters the abdominal cavity near the belly button using a Veress needle or an open incision and placing a laparoscope.
The provider insufflates the abdomen with CO2 gas to create a pneumoperitoneum and then puts the patient into the Trendelenburg position. He then makes small incisions around the abdominal area to insert trocars to view the operating site better and insert surgical tools.
If he is performing robotic surgery, he docks the robot to the laparoscope at this time. He then places a combination uterine manipulator–colpotomizer device into the uterus through the cervix so that he can move the uterus around while looking through the laparoscope and later guide the incisions to remove the uterus.
He then identifies the course of the ureters and dissects them freely to ensure he does not cut them during the surgery.
Next, the provider uses a heated instrument to desiccate, or dry up, the infundibulopelvic ligaments.
Then, he does the same to the veins that run between the ovary and the round ligaments.
Then he incises the round ligaments and dissects the uterus from the anterior and posterior broad ligaments. He then incises the infundibulopelvic ligaments with a scalpel and mobilizes, or frees, the bladder of the lower uterine segment.
Next, the provider strips the uterine arteries from the surrounding tissue and ligates or ties them. The provider then incises and clamps the cardinal and uterosacral ligaments.
With the colpotomizer in place, he makes a circular incision around the anterior and posterior vagina. He then removes the uterus, cervix, and fallopian tubes, with or without the ovaries, through the vagina.
The provider usually does not have to use a morcellator to reduce the size of the uterus because it is normal.
Still, if he does, he can also remove the uterus and the other structures through one of the trocar ports instead of vaginally.
Once he completely removes the organs, the provider places a sponge or other device into the vaginal cuff area and reinflates the abdominal cavity.
He then sutures the vaginal cuff through the laparoscope from above. He uses these sutures to fold and shorten the uterosacral tissues to prevent the formation of an enterocele or small bowel prolapse into the vaginal canal.
He confirms that there is no bleeding; he deflates the abdomen and removes all instruments and trocars.
Finally, he closes all the trocar sites with sutures at the fascia and skin level.
How To Use CPT 58571
To distinguish a total laparoscopic hysterectomy billed with CPT 58571 from a laparoscopic-assisted vaginal hysterectomy, the following must be met:
The provider severs all connections through the scope, removes the uterus through the scope by cutting it into small pieces or through the vaginal canal, and the vaginal cuff is sewn from above through the laparoscope.