Ob-Gyn Coding Alert

Question: During a laparoscopic supracervical hysterectomy (LSH), the ob-gyn performed a cervical suspension before morcellating the uterus down to the cervix. The op report states that he made relaxing incisions bilaterally beneath the uterus and then drove through a suture of 2-0 Ethibond. The ob-gyn grasped the uterosacral ligament on the left side, then drove through the uterosacral ligament, then to the back of the cervix, and then through the right uterosacral ligament. He tied the sutures together. He did this three more times to elevate the cervix and give it good support. I can't find a CPT code for this and am using an unlisted-procedure code for the LSH. Any ideas? 


Florida Subscriber


Answer: Although the ob-gyn performed a cervical uterosuspension laparoscopically, you could consider reporting 57425 (Laparoscopy, surgical, colpopexy [suspension of vaginal apex]). You should contemplate this code because the technique an ob-gyn uses to suspend the vaginal vault is identical to the procedure performed by this physician. The only difference is that the ob-gyn is attaching the cervix, not the vaginal apex, to the uterosacral ligaments.

Keep in mind: If you were reporting the laparoscopic supracervical hysterectomy using 58550 (Laparoscopy surgical, with vaginal hysterectomy, for uterus 250 grams or less), you will need to append modifier 52 (Reduced services) because the ob-gyn did not remove the cervix. In this case, the code order will be 57425, 58550-52. If you report some other laparoscopic vaginal hysterectomy code, this code order may reverse if the LSH, even as a reduced service, has a higher value than the colpopexy.

If you were reporting the LSH using 58578 (Unlisted laparoscopy procedure, uterus), then simply report 58578 with no modifier if you have listed it first on the claim or add modifier 51 (Multiple procedures) if you listed it second. And remember, of course, to send in documentation to support the LSH procedure.