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A total laparoscopic hysterectomy (TLH) is a minimally invasive surgical procedure aimed at the complete removal of the uterus, specifically when it weighs 250 grams or less. This procedure is typically performed through the vagina while keeping the uterus intact, which allows for a more efficient recovery and less postoperative pain compared to traditional open surgeries. The process begins with the insertion of a urinary catheter into the bladder via the urethra to ensure the bladder is empty during the operation. Following this, the cervix is dilated, and a uterine sound is utilized to measure the length of the uterus, which aids in the surgical planning. A uterine manipulator is then placed transvaginally through the cervix to facilitate the maneuvering of the uterus during the procedure. To maintain the integrity of the surgical field, a vaginal extender, also known as a cervical cup, is positioned, and an occlusion device is inserted to prevent the loss of air from the peritoneal cavity. The surgeon makes an incision below the umbilicus to insert a laparoscope, which is a specialized camera that allows for visualization of the abdominal cavity. The abdomen is insufflated with gas to create a working space for the surgery. Additional incisions are made in the suprapubic area and bilaterally near the hip bones to accommodate other surgical instruments necessary for the procedure. During the surgery, the ureters are carefully identified and protected to prevent injury. The peritoneum covering the bladder is incised, allowing for the dissection of the bladder from the lower uterine segment, thereby exposing the anterior vagina. An incision is made into the anterior aspect of the vagina, which is then extended laterally and posteriorly while preserving the uterosacral ligament to maintain pelvic support. The utero-ovarian ligament, along with the uterine attachments and associated blood vessels, are divided to facilitate the removal of the uterus. The patient is positioned in high lithotomy to optimize access to the surgical site, and the pneumoperitoneum is allowed to escape. The uterus and cervix are then delivered into the vagina and removed. After the uterus is excised, the occlusion device is replaced, and the abdomen is reinflated to ensure a clear surgical field for closure. Finally, the vagina is closed using laparoscopic suturing techniques at the apex, which are reinforced with sutures in the uterosacral ligaments to prevent future vaginal prolapse. This procedure is coded under CPT® Code 58570, and if the tubes and/or ovaries are also removed, CPT® Code 58571 should be used.
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The total laparoscopic hysterectomy (TLH) procedure, coded as CPT® 58570, is indicated for various conditions affecting the uterus. These indications include:
The total laparoscopic hysterectomy involves several key procedural steps, which are detailed as follows:
After the total laparoscopic hysterectomy, patients can expect a recovery period that may vary based on individual health factors and the extent of the surgery. Post-procedure care typically includes monitoring for any signs of complications, such as excessive bleeding or infection. Patients are often advised to avoid heavy lifting and strenuous activities for a specified period to promote healing. Follow-up appointments are essential to assess recovery and address any concerns. Pain management may be necessary, and patients are usually provided with instructions regarding activity restrictions and signs to watch for that may indicate complications. Overall, the minimally invasive nature of the procedure generally allows for a quicker recovery compared to traditional open hysterectomy methods.
| Short Descr | TLH UTERUS 250 G OR LESS | Medium Descr | LAPAROSCOPY W TOTAL HYSTERECTOMY UTERUS 250 GM/< | Long Descr | Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 2 - Co-surgeons permitted and no documentation required if the two- specialty requirement is met. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1E - Major procedure - hysterctomy | MUE | 1 | CCS Clinical Classification | 124 - Hysterectomy, abdominal and vaginal |
This is a primary code that can be used with these additional add-on codes.
| 49327 | Addon Code MPFS Status: Active Code APC N ASC N1 Laparoscopy, surgical; with placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), intra-abdominal, intrapelvic, and/or retroperitoneum, including imaging guidance, if performed, single or multiple (List separately in addition to code for primary procedure) |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AG | Primary physician | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CR | Catastrophe/disaster related | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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| 2013-01-01 | Changed | Medium Descriptor changed. |
| 2011-01-01 | Changed | Short description changed. |
| 2010-01-01 | Changed | Code description changed. |
| 2008-01-01 | Added | First appearance in code book in 2008. |
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