Surgical Procedures on the Female Genital System -Common Language Code Description

58552 Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s)

Common Language Description The physician performs a laparoscopically assisted vaginal hysterectomy (LAVH) for a uterus weighing 250 grams or less with or without removal of tubes and/or ovaries. An incision is made just below the umbilicus and a trocar placed, and the laparoscope is inserted. The abdominal cavity and uterus are visually inspected. Two or three portal incisions are made in the lower abdomen for introduction of surgical instruments. Using bipolar coagulation to control bleeding, the round ligaments are transected followed by transection of the broad ligament. Ring forceps are placed in the vagina to elevate the vaginal apex while the bladder flap is developed using blunt and sharp dissection. The bladder pillars are coagulated and transected. The perivesical and perivaginal spaces are developed using blunt and sharp dissection. A linear stapler is used to transect either the infundibulopelvic or utero-ovarian ligaments depending on whether the tubes and/or ovaries are being removed. The ascending branch of the uterine artery is transected. The upper aspect of the vaginal wall is incised. The cardinal ligament is approached vaginally, cross-clamped, divided, and suture ligated. The uterus is delivered through the vaginal incision and removed. The vaginal cuff is closed. Following closure of the vaginal cuff, the abdomen is inspected laparoscopically and any bleeding controlled by laser cautery. The abdomen is irrigated; instruments are removed; and the portal incisions are closed. Use code 58550 for LAVH without removal of tubes and/or ovaries or code 58552 when the tube(s) and/or ovary(ies) are also removed.



58150 Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s);

Common Language Description The physician performs a total abdominal hysterectomy with or without removal of the fallopian tubes and/or ovaries. An incision is made in the abdomen and the anterior uterine surface exposed. The peritoneum at the cervicovesical fold is incised. Blunt dissection is used to expose the broad ligament, round ligament, and fallopian tubes. If the fallopian tubes and/or ovaries are removed, an incision is made in the exposed broad ligament. The ovarian vessels are visualized and suture ligated. The cut edges of the broad ligament are plicated with mattress sutures. The fallopian tubes and ovaries are dissected free of surrounding tissue. The round ligaments are clamped and divided, and blood vessels are suture ligated bilaterally. The cervix is palpated and the position of the bladder ascertained. The bladder is then dissected off the uterus and the dissection carried down to the vaginal wall. The posterior aspect of the uterus is visualized and inspected to verify that it is not adhered to the rectum. The uterine vessels are exposed, clamped, divided, and suture ligated. The posterior cervical peritoneum is incised and the incision is extended around the cervix. The vaginal wall is incised and the cervix separated from the vagina. The uterus and cervix with or without the ovaries and tubes are removed. The vaginal opening is closed. The surgical site is inspected, bleeding controlled, and the abdominal incision closed. In 58152, a total abdominal hysterectomy is performed with a colpo-urethrocystopexy with or without removal of tubes and/or ovaries. The hysterectomy is performed as described above. The prolapsed vaginal wall and urethra are then suspended. Two sutures are placed through the paravaginal fascia, one on each side of the urethrovesical junction, oriented perpendicular to the vaginal axis. The sutures are then passed through the Cooper's ligament, pelvic fascia, or pubic bone and tied to provide suspension and support to the bladder and urethra. If additional suspension is required, a second set of sutures may be placed along the base of the bladder.


58240 Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof

Common Language Description The physician performs pelvic exenteration for gynecologic malignancy. This procedure includes a total abdominal hysterectomy or cervicectomy with or without removal of tubes and/or ovaries, removal of the bladder with ureteral transplantations, and/or abdominoperineal resection of the rectum and colon with colostomy. The abdomen is opened and explored. The liver, peritoneum, bowel, and aortic and pelvic lymph nodes are carefully inspected. Biopsies are taken as needed. The pararectal, paravesical, and Retzius spaces are opened and the cardinal ligaments are exposed. The round ligaments are cut and tied and the broad ligaments are opened. The infundibulopelvic ligaments, in conjunction with the ovarian vessels, are clamped, cut, and tied. The retroperitoneal space is opened and the ureters are exposed. The hypogastric artery is identified and divided. The cardinal ligaments are divided. The ureters are dissected free of surrounding tissue, ligated, and divided. The rectal space between the rectosigmoid colon and the sacrum/coccyx is developed. The sigmoid arcade and the superior vessels are ligated. The rectosigmoid colon is divided. The rectum is elevated and freed from surrounding tissues. The bladder is freed from the pubic symphysis. The urethra, rectum, and vagina are divided below the level of the malignancy, leaving adequate margins of healthy tissue. All involved pelvic organs are removed, including some or all of the following: ovaries, tubes, uterus, cervix, bladder, distal ureters, rectum, and colon. Following removal of involved organs, the rectum/colon is anastomosed or a colostomy is performed. The proximal ureters are then transplanted to provide urinary diversion. If noncontinent diversion is employed, an ileal urinary conduit may be created by implanting the ureters into a segment of small bowel that is then brought out in a cutaneous stoma. Alternatively, a continent pouch using the right colon may be developed. The exenterated pelvis is then reconstructed using omental, myocutaneous, and/or muscle flaps.

58260 Vaginal hysterectomy, for uterus 250 g or less; 

Common Language Description The physician performs a vaginal hysterectomy on a uterus weighing 250 grams or less. Tenacula are placed on the cervix. The vaginal mucosa is incised around the entire cervix. Traction is applied to the tenacula, and the bladder is separated from the uterus using blunt and sharp dissection. The bladder is elevated to expose the peritoneal vesicouterine fold, which is then incised. The cul-de-sac is exposed and the peritoneum incised. The broad ligament is exposed. The uterosacral ligaments are clamped and divided. The cardinal ligaments are clamped at the lower uterine segment, incised, and suture ligated. The lower portion of the broad ligament is clamped and divided at its attachment to the lower uterine segment. The posterior uterine wall is grasped and the uterus delivered into the vagina. The tubo-ovarian round ligaments are exposed, clamped, and incised close to the uterine fundus bilaterally. The fallopian tubes are transected. The tubo-ovarian round ligaments are doubly ligated. The uterus is removed. The fallopian tubes are returned to the abdomen. Alternatively, if the tubes and ovaries are to be removed, the round ligament is cut and tied bilaterally. Tension is then applied to the infundibulopelvic ligament, which is cut, allowing delivery of the tubes and ovaries along with the uterus into the vagina, and all of these structures are removed. The anterior vaginal wall is elevated. The entire length of the broad ligament is exposed and bleeding controlled. The peritoneum is closed. The vaginal cuff is left open for drainage of the pelvis. Use code 58260 when only the uterus is removed. Use code 58262 when the uterus is removed along with the tubes and ovaries. Use code 58263 when the uterus, tubes, and ovaries are removed and an enterocele is repaired. To repair the enterocele, the vaginal mucosa overlying the enterocele is opened. The perirectal fascia is dissected free of the posterior vaginal mucosa to expose the enterocele sac. The sac is incised and the small bowel pushed back into the abdomen. The sac is closed with two purse-string sutures placed around the neck of the enterocele. The redundant sac is excised.


58541 Laparoscopy, surgical, supracervical hysterectomy, for uterus 250 g or less; 

Common Language Description Laparoscopic supracervical hysterectomy (LSH) is performed to remove a uterus 250 g or less. LSH is a minimally invasive way to remove the uterus as an alternative to total abdominal hysterectomy. LSH maintains better pelvic support because the ligaments that hold up the vagina and cervix are left intact. This procedure also preserves sexual function by maintaining the cervix and its secretory glands. LSH is not performed on cancer patients or those with a history of precancerous cervical pathology. A retractor is placed vaginally into the cervix to aid in moving the uterus for visualization. A small belly button incision and two small hip bone area incisions are made for placing the laparoscopic instruments and the abdomen is inflated with carbon dioxide gas. The scope is inserted in the belly button incision and the cutting/grasping instrument and retractor are operated through the other two incisions. The uterus alone (58541) or the uterus along with the fallopian tubes and/or ovaries (58542) is separated from the blood supply and released from its attachment to the cervix. Permanent sutures are placed in the ligaments that hold up the cervix for greater support against later prolapse. The center of the cervix is coagulated to prevent bleeding problems, and then the cervix is covered with peritoneum, the lining of the abdomen. Instruments are then changed to a morcellator, a rounded blade on the end of a tube, and a small camera. The uterus with or without tubes and/or ovaries is delivered out of the abdomen in strips and sent to pathology. Bleeders are coagulated, instruments are removed, and the gas is emptied from the abdomen before closing the incisions.

58550 Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 g or less;

Common Language Description The physician performs a laparoscopically assisted vaginal hysterectomy (LAVH) for a uterus weighing 250 grams or less with or without removal of tubes and/or ovaries. An incision is made just below the umbilicus and a trocar placed, and the laparoscope is inserted. The abdominal cavity and uterus are visually inspected. Two or three portal incisions are made in the lower abdomen for introduction of surgical instruments. Using bipolar coagulation to control bleeding, the round ligaments are transected followed by transection of the broad ligament. Ring forceps are placed in the vagina to elevate the vaginal apex while the bladder flap is developed using blunt and sharp dissection. The bladder pillars are coagulated and transected. The perivesical and perivaginal spaces are developed using blunt and sharp dissection. A linear stapler is used to transect either the infundibulopelvic or utero-ovarian ligaments depending on whether the tubes and/or ovaries are being removed. The ascending branch of the uterine artery is transected. The upper aspect of the vaginal wall is incised. The cardinal ligament is approached vaginally, cross-clamped, divided, and suture ligated. The uterus is delivered through the vaginal incision and removed. The vaginal cuff is closed. Following closure of the vaginal cuff, the abdomen is inspected laparoscopically and any bleeding controlled by laser cautery. The abdomen is irrigated; instruments are removed; and the portal incisions are closed. Use code 58550 for LAVH without removal of tubes and/or ovaries or code 58552 when the tube(s) and/or ovary(ies) are also removed.

58570 Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less;

Common Language Description A total laparoscopic hysterectomy (TLH) is performed to remove a uterus weighing 250 grams or less, typically through the vagina and still intact, in 58570. A urinary catheter is inserted into the bladder through the urethra, the cervix is dilated, and a uterine sound is inserted to measure the uterine length. A uterine manipulator is placed transvaginally through the cervix. A vaginal extender (cervical cup) is placed and an occlusion device is inserted to prevent loss of air from the peritoneum. An incision is made below the umbilicus, the laparoscope is inserted, and the abdomen is insufflated. An additional suprapubic incision and bilateral incisions near the hip bones are made for other surgical instruments. The ureters are identified and protected. The peritoneum overlying the bladder is incised. The bladder is dissected off the lower uterine segment and the anterior vagina is exposed. An incision is made into the anterior aspect of the vagina and extended laterally and posteriorly, while preserving the uterosacral ligament. The utero-ovarian ligament, uterine attachments, and blood vessels are divided. The patient is placed in high lithotomy position and the pneumoperitoneum is allowed to escape. The uterus and cervix are then delivered into the vagina and removed. The occlusion device is replaced and the abdomen is reinflated. The vagina is closed by laparoscopic suturing of the apex, which is supported with sutures in the uterosacral ligaments to prevent vaginal prolapse. Use 58571 when the tube(s) and/or ovary(s) are also delivered into the vagina and removed with the uterus.

58661 Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy)

Common Language Description The physician may remove part or all of one or both fallopian tubes and/or ovaries. A tenaculum is inserted into the vagina, the cervix is grasped, and the uterus is anteflexed. A periumbilical port is placed and pneumoperitoneum is established by insufflating with air. The laparoscope is inserted and the abdominal cavity is inspected. The fimbrial end of the fallopian tube and ovary are elevated. A window is created in the peritoneum of the broad ligament and the infundibulopelvic ligament is grasped, ligated, and transected. The posterior leaf of the broad ligament is severed up to its attachment to the uterus. The fallopian and ovarian ligament is coagulated or ligated with an endoloop at the uterus and severed. A clip is placed across the superior portion of the broad ligament and across the base of the tube at its junction with the uterus. The tube is then severed and removed with or without the ovary through the endoscopic port, or placed in an endobag and removed. The pelvic area is inspected for bleeding, the instruments are withdrawn, and pressure is applied to the abdomen to express any remaining air in the peritoneum. The portal incisions are closed.