# LAVH+Cervix



## amyj.howe (Jul 26, 2012)

Patient had a LAVH, however Cervix was also delivered vaginally. Normally I would only code the 58550 (as the total weight was under 250 g), however the more I think about it, I see that the removal of the Cervix is included in the procedure for a Total Hysterectomy but not the LAVH. I feel that 58550 (LAVH) is more appropriate for this procedure due to the vaginal delivery, however was wondering what your thoughts would be about a 22 mod to indicate the additional work for the Cervix.

Thanks!


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## bonzaibex (Jul 26, 2012)

58550 includes removal of the cervix.  Here's what I found on SuperCoder under the Lay Term heading for 58550:
Physician Responsibility
What makes this a LAVH is that the physician severs all the upper connections of the uterus via the scope, but the physician severs the lower connections from below. The physician removes the uterus and cervix vaginally. Then, the physician sews the vaginal cuff from below via the vaginal canal. 

Becky, CPC


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## preserene (Jul 26, 2012)

Yes,  LAVH  is itself total vaginal hysterctomy. cervix is a part of the uterus( cervix uteri).So as Bonzaibex said, whether it is removed in piecemeal via either route does not matter, it the procedure that is important. 

hope this terminology would help, you all know , though. Just for refreshing:
TAH - 58150- 58152.
TVH - 58260-58270.
PUROH - CESAEREAN HYSTERECTOMY - 59525.
LAVH -  LA.P ASST VAG. HYST - 58550-58554
TLH,  LH -Total  LAPAROSC. HYSTERECTOMY- 58570- 58573
LSH - LAPRO. SUPRA CERVICAL HYSTERECTOMY - 58541-58544.


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## preserene (Jul 26, 2012)

Yes,  LAVH  is itself total vaginal hysterctomy. cervix is a part of the uterus( cervix uteri).So as Bonzaibex said, whether it is removed in piecemeal via either route does not matter, it the procedure that is important. 

hope this terminology would help, you all know , though. Just for refreshing:
TAH - 58150- 58152.
TVH - 58260-58270.
PUROH - CESAEREAN HYSTERECTOMY - 59525.
*LAVH -  LAP ASST VAG. HYST - 58550-58554*
TLH,  LH -Total  LAPAROSC. HYSTERECTOMY- 58570- 58573
LSH - LAPRO. SUPRA CERVICAL HYSTERECTOMY - 58541-58544.

RADICAL HYST- 58548 LAP. ABDOMINAL 58200- 58240; VAGINAL - 58275-58285.

*OTHERS:  * 
SUBTOTAL HYST/ SUPRACERVICAL HYST - 
PARTIAL HYST- SYN- SUPRACERVICAL, COMPLETE ,INCOMPLETE.

MODIFIED RADICAL HYSTERECTOMY ANOTHER SEPARATE ENTITY.


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## bonzaibex (Jul 26, 2012)

More info, because your question made me realize I have always assumed you couldn't do a LAVH without taking the cervix, and assuming stuff like that has bit me in the posterior region more than once:

http://en.wikipedia.org/wiki/LAVH#Technique
LAVH begins with laparoscopy and is completed such that the final removal of the uterus (with or without removing the ovaries) is via the vaginal canal. Thus, LAVH is also a total hysterectomy, the cervix must be removed with the uterus.

Becky, CPC


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## amyj.howe (Jul 26, 2012)

It's funny reading that in black and white makes me realize that I had an absolute blonde moment at the point in which I posted this thread. Thanks for the points of reference bonzaibex!


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