CPT Code 58571 | Total Laparoscopic Hysterectomy
CPT 58571 describes the surgical procedure in which the provider utilizes a laparoscope to make incisions in all of the uterine, ovarian, and cervical connections, and subsequently removes the uterus, cervix, and fallopian tubes, with or without the ovaries, either through the trocar ports or through the vaginal canal, with the uterus weighing 250 g or less.
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).”
Procedure
The procedure described by CPT code 58571 involves the removal of a uterus and ovaries, if necessary. It is a laparoscopic surgery that requires the patient to be in the dorsal lithotomy position during the procedure. The provider first preps and drapes the abdomen before administering a general anesthetic. Then, the provider enters the abdominal cavity near the belly button using a Veress needle or an open incision to place a laparoscope. This allows the provider to view the operating site better.
To create a pneumoperitoneum, the provider insufflates the abdomen with CO2 gas. The patient is then placed in the Trendelenburg position. The provider makes small incisions around the abdominal area to insert trocars. This ensures a better view of the operating site and allows the provider to insert surgical tools. If the provider is performing robotic surgery, he docks the robot to the laparoscope at this time.
Next, the provider places a combination uterine manipulator/colpotomizer device into the uterus through the cervix. This allows the provider to 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 free to ensure that he does not cut them during the surgery.
The provider uses a heated instrument to desiccate, or dry up, the infundibulopelvic ligaments. He does the same to the veins that run between the ovary and the round ligaments. The provider then incises the round ligaments and dissects the uterus from the anterior and posterior broad ligament. He incises the infundibulopelvic ligaments with a scalpel and mobilizes, or frees, the bladder off the lower uterine segment.
Next, the provider strips the uterine arteries from the surrounding tissue and ligates or ties them. He 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. The uterus, cervix, and fallopian tubes are then removed, 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 of normal size. However, if necessary, he can also remove the uterus and the other structures through one of the trocar ports instead of vaginally.
After completely removing 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 and 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. The provider confirms that there is no bleeding, deflates the abdomen, and then removes all instrument and trocars.
Finally, the provider closes all of the trocar sites with sutures at the level of both the fascia and the skin. This ensures that there is no infection and reduces the risk of herniation. It is important to note that this is a complex surgery that requires a skilled provider. Patients should discuss the risks and benefits of this procedure with their healthcare provider before determining if it is right for them.
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.
Return to all the CPT codes for laparoscopic/hysteroscopic procedures on the corpus uteri.
