Question:
What is the difference between 58550 (laparoscopy with vaginal hysterectomy or LAVH) and 58570 (total laparoscopic hysterectomy or TLH)? I always thought that with the LAVH, the ob-gyn pulled out the uterus vaginally after he cut the ligaments through the scope. With the TLH, the ob-gyn cut the uterus with a morcellator and pulled out in pieces through the scope. A couple of physicians I code for are labeling their surgeries TLH's and wanting to bill 58570, but reading the op reports I see that they pulled the uterus out vaginally in one piece. What should I tell them?
Oregon Subscriber
Answer:
For a total laparoscopic hysterectomy (TLH), the ob-gyn can remove the uterus via the scope or vaginally in one piece. What makes the difference is how the ob-gyn severs the connections and how the ob-gyn sews the vaginal cuff.
Difference 1: In the laparoscopic with vaginal hysterectomy (LAVH) cases, the ob-gyn severs only the upper connections via the scope. In the TLH case, the ob-gyn severs both upper and lower connections through the scope.
Difference 2: In an LAVH, the ob-gyn enters the vaginal wall from below to remove the uterus. In a TLH, the ob-gyn circumscribes the cervix from above to release the organ and pull it through the vaginal canal. Note that he can also remove the uterus using the scope after morcellating the uterus, but either approach can still represent the TLH.
Difference 3: In an LAVH, the ob-gyn sews the vaginal cuff closed from below, in a TLH, it is sewn closed via the scope.
