# Radical hysterectomy



## FractalMind (May 19, 2009)

Hi, we often receive TAH W/BSO & Lymph nodes excision, is this considered radical hysterectomy? I just received a case: "Laparoscopic assisted vaginal hysterectomy w/BSO & lymph node excision...Can I use code 58548?
I just want to know what makes a hysterectomy Radical, is it the lymph node excision?

Thanks.
Erika


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## JessicaHeemskerk (May 20, 2009)

Do you have an example of the operative report. Because a TAH and LAVH are so different.  Where are the lymph nodes take from?  I am assuming the patient has cancer.??  Was there staging done during the procedure.  ??


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## magnolia1 (May 20, 2009)

Refer to link below for description:

http://cancer.about.com/od/cancersaffectingwomen/f/radicalhysterec.htm


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## FractalMind (May 20, 2009)

No, actually I'm coding for anesthesia but 1st I need to assign the surgical code, this was an 8 hr procedure and it's for cancer, I don't have access right now to the op-report but I always code the radical hysterectomy when there's lymph nodes excision, I spoke to my fellow coder who asked a OBGYN dr what's considered radical and she answered that anytime that lymph nodes or significant amount of surrounding tissue is removed, that's considered radical. My other co-worker does not agree and will only code for total hysterectomy.


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## FractalMind (May 20, 2009)

Thanks Karen, I already did look at that and according to the definition, the procedure I'm coding for is a radical hysterectomy...I just wanted more supporting information because I don't want to up-code, if it's total I'll just code total hysterectomy.


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## krssy70 (Oct 21, 2009)

*Radical Hysterectomy*

The following info is copied from the custom coder website. I hope this is helpful.  Keep in mind, you cannot use this code unless the surgeon is removing the pelvic and periaortic lymph nodes. If he is removing other lymph nodes, then you must code them separatley and code a total abdominal hysterectomy.. 

The physician performs a radical abdominal hysterectomy with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling biopsy, with or without removal of tubes and/or ovaries. A radical hysterectomy is most commonly performed for cervical cancer and involves more extensive surgery than a total hysterectomy. Tissue surrounding the uterus and the upper vagina are also removed. The abdomen is incised. Before opening the peritoneum, pelvic lymph nodes are explored and removed. Taking care to preserve the genitofemoral nerve and psoas muscle, fatty tissue is stripped from the mid-portion of both common iliac vessels and along the internal and external iliac vessels to the level of the circumflex iliac vein. Iliac, hypogastric, and obturator nodes are excised bilaterally and sent for separately reportable frozen section exam. The peritoneal cavity is opened and the abdomen and pelvis are explored for evidence of metastatic disease. The para-aortic lymph nodes are exposed and biopsies are taken and sent for frozen section. 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 bladder is mobilized and the uterus is exposed. The uterine artery and vein are ligated. The ureters are dissected from the parametrium and from the tunnel of the cardinal ligament. The posterior peritoneum and rectovaginal space are opened. The uterosacral ligaments are freed and divided as are the cardinal ligaments. The parametria is freed from inferior attachments to the level of the vagina. The uterus, cervix, and pelvic tissue around the uterus are removed with or without removal of the ovaries and/or tubes. The proximal portion of the vagina is also excised. An incision is made across the top of the vaginal vault. Two longitudinal full-thickness incisions are then made, one along the ventral (anterior) aspect and a second along the dorsal (posterior) aspect of the vaginal wall. The bladder and rectal pillars are transected at their attachment sites on the bladder and rectum. The anterior and posterior vaginal walls along with the two lateral paravaginal spaces are resected. The upper portion of the vagina is then removed. Separately reportable vaginal reconstruction with skin grafts may be performed at the same or a subsequent surgical session.

Kristen Richard, CPC


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