# Need help coding this.... - uterine manipulator



## AGRIFF30 (May 30, 2014)

I'm unfamiliar w/ surgery coding for GYN and any guidance would be greatly appreciated.
I came up with 58571 and 58662 but unsure

Here are the notes....
The patient was placed in dorsal lithotomy position and prepped and draped in standard fashion.  Attention was first turned vaginally where a uterine manipulator was placed into the cervix w/out difficulty, 6 tip was used with a 3x3 cup, suture placed around the cervix was verified.  Attention was then turned abdominally. A 10mm infraumbilical skin incision was made with a scalpel and carried through to the underlying fascia.  The fascia was grabbed with Kochers, incised and intraperitoneal access confirmed digitally and then visually with camera.  The 10 mm trocar was introduced and then camera placed intra-abdominally.  Abdomen was insufflated with CO2 gas.  Three additional ports were put in the right and left lower quadrants and right upper quadrant with 5mm incisions made with a scalpel and 5mm ports entered under direct visualization. The pelvis was surveyed.  A 5cm right endometrioma was seen, a normal uterus, distended right fallopian tube with a blunted end filled with chocolate fluid, scattered endometriosis throughout the pelvis, adhesions of the bowel to the lower uterine segment as well as into the bladder.  Attention was first turned to the bowel adhesions that were taken down from the lower uterine segment and away from the left adnexa.  Decision was made to proceed first with the total laparoscopic hysterectomy and leave the endometrioma for last.  The left pedicle, left uteroovarian ligament complex was cauterized and ligated with Ligasure.  Ligasure was continued down to the broad ligament. The ureter was visualized.  The peritoneum along the front of the uterus was brought down.  Dense adhesions were encountered of the bladder to the lower uterine segment given the patient's prior 2 cesarean sections as well as endometriosis.  Attention was turned to the bladder and pushed away from the lower uterine segment.  During this process, the ureter was visualized during the entire procedure.  Attention was then turned to the right adnexa.  The distended fallopian tube was dissected away from the ovary along the broad ligament.  We continued down with the LigaSure, doubly ligating the uteroovarian ligament, carrying it down the broad ligament to the area of the insertion of the uterine arteries.  Again, the anterior peritoneum was taken down with mom shears and eventually, the bladder was dissected off the lower uterine segment after many adhesions were dissected.  At this time, attention was turned to the uterine arteries which were cauterized with ligasure and transected. Mono shears and monopolar were used to incise the vaginal cuff circumferentially around the cervix w/out difficulty, transecting the uterus completely.  The uterus was removed from the vagina.  Attention was then turned to the left adnexa.  The left pedicle was identified with the IP ligament identified distant from the ureter.  the bowel was adherent to this whole adnexal complex.  This was taken down with sharp dissection until freed and the ureter could be identified distant and separate from the IP ligament.  This was then grasped with ligasure, cauterized and transected removing the left ovary and tube. This as well as the uterus was removed from the vagina.  the cuff was closed w 0V-Loc suture in running fashion.  The pelvis was inspected.  Pedicles were inspected and found to be hemostatic.  The cuff was inspected and found to be hemostatic. The pelvis and abdomen were irrigated.  All instruments were then removed from the vagina...

Findings: EUA-NEFG, well estrogenized vaginal mucosa, mobile anteverted 6wk sized uterus. Laparoscopy-6cm left adnexal endometrioma, left adnexa with adhesions to adjacent bowel, significant adhesions from bladder to anterior uterine wall, right fallopian tube dilated with endometrmetriold material. procedures performed -enterolysis, left salpingo-oophorectomy, TLH with right salpingectomy.


----------



## KPriceAZ08 (Jun 25, 2014)

If the uterus was 250g or less, I would use 58571 only.  58662 is included.


----------

