# Laporoscopic hysterectomy



## DMW610 (Feb 24, 2015)

I need clarification of the difference between 58550-58554 series and the 58570-58573 series. Thanks


----------



## melawar (Feb 24, 2015)

*LAVH vs TLH*

Copied from article:

Laparoscopy with Vaginal Hysterectomy (LAVH), indicated by CPT codes 58550 to 58554.  LAVH includes laparoscopically detaching the uterine body from the surrounding upper supporting structures. The vaginal portion of the procedure is then performed. The vaginal apex is entered and the cervix and uterus are detached from the remaining supporting structures. The uterus is then removed through the vagina. 

Laparoscopic Hysterectomy (TLH), indicated by CPT codes 58570 to 58573.  Although it is not in numerical sequence with TLH, you would also include laparoscopic radical hysterectomy with pelvic lymphadenectomy (CPT 58548) in this code set.  TLH includes laparoscopically detaching the entire uterine cervix and body from the surrounding supporting structures and suturing the vaginal cuff.  It includes bivalving, coring, or morcellating the excised tissues, as required. The uterus is then removed through the vagina or abdomen.


----------



## Amanda.Kane (Feb 26, 2015)

*Where to Look*

The best thing to do is to read the full description in a Coding Companion book. They give step by step what to look for in each code. If you don't have one of those, I find the below website very helpful for OBGYN case. It's a breakdown of some of the common OBGYN procedures. Warning: If can be graphic, as it has drawings of every sketch.

http://atlasofpelvicsurgery.com/5Uterus/11Laparoscopy-AssistedVaginalHysterectomy/chap5sec11.html

Hope that helps!

Amanda Kane, CPC, COBGC


----------



## DMW610 (Feb 26, 2015)

Thanks for the information. I think my confusion is that my provider always does a colpotomy and removes the uterus, cervix and ovaries/tubes that way. That is why I've been billing from the 5855_series and not the 5857_series. I've checked the Coder's desk reference and it states that when using the 
5857_ series the specimens are removed by morcellization. There is no mention of that in this provider's op notes. I've done some more research on the terms coring and bivalving and it seems that those are different morcellization techniques. At this point I feel that I have been coding these correctly. Thanks for the input.


----------



## Amanda.Kane (Feb 27, 2015)

Good morning!

Just an additional question: Was the uterus removed through the vagina or through the abdomen?

I found another article on the ACOG site that includes the morcellating tissue as you mentioned but also comments that in a LAVH the uterus is removed from the vagina and in a TLH it can be removed from the vagina or the abdomen. It might help in the future if you run into this issue again to look at the extraction method.

Link:
http://www.acog.org/About-ACOG/ACOG-Departments/Coding/Coding-Laparoscopic-Hysterectomy-Procedures

Thanks!
Amanda Kane, CPC, COBGC


----------

