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Basics of Hysterectomy CPT code 58150, 58180 & 58210

We have learnt about diagnostic exam hysterosalpingogram previously, but today we move a step forward and learn about the surgery codes used for removal of uterus called Hysterectomy.

Hysterectomy CPT codes in surgery section have specific procedures codes (CPT code 58150, 58180 & 58210). The codes have been arranged on the basis of approach and extent of removal. Their are around 30 hysterectomy procedure codes and hence, to find the correct code you have to first check the surgical approach and extent of the procedure.

Different approach for hysterectomy procedure codes

The surgical approach is an important factor to filter out the hysterectomy cpt codes. The approach can be abdominal, vaginal and laproscopic.

Abdominal– the uterus is removed via an incision in the lower abdomen

Vaginal– the uterus is removed via an incision in the vagina

Laproscopic – the procedure is performed using a laproscope , inserted via several small incisions in the body.

Their are also CPT codes for laproscopic assisted vaginal approach. In this procedure ,the scope is inserted via a small incisions in the vagina.

Extent of the procedure to choose the Correct Hysterectomy CPT code

Extent of the procedure is also an important factor for finding the correct CPT code for hysterectomy exam. There are three options mainly:

Total hysterectomy: It includes laparoscopically detaching the entire uterine cervix and body from the surrounding supporting structures and suturing the vaginal cuff. It includes bivalving, coring, or morcellating the excised tissues, as required. The uterus is then removed through the vagina or abdomen.

Subtotal, partial or supracervical hysterectomy: It is the removal of the fundus or op portion of the uterus only, leaving the cervix in place.

Radical hysterectomy: It includes the removal of the entire uterus and nearby tissue, the cervix and the top par to the vagina.

Laparoscopy Assisted Vaginal Hysterectomy (LAVH): It includes laparoscopically detaching the uterine body from the surrounding upper supporting structures. The vaginal portion of the procedure is then performed. The vaginal apex is entered and the cervix and uterus are detached from the remaining supporting structures. The uterus is then removed through the vagina.

But, still many codes are doubtful when the coder knows the approach and the extent of the procedure. For example the below CPT code

58150 : Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s)

The above code includes removal of tubes and ovaries, if performed.

58180 : Supracervical abdominal hysterectomy (subtotal hysterectomy), with or without removal of tube(s), with or without removal of ovary(s)

58210 : Radical abdominal hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy), with or without removal of tube(s), with or without removal of ovary(s)

Top Diagnosis Codes ICD10 CM for Hysterectomy CPT code 58150, 58180 & 58210

D25      Leiomyoma of uterus 17.09%
C54      Malignant neoplasm of corpus uteri 12.81%
D27      Benign neoplasm of ovary 9.04%

C53 Malignant neoplasm of cervix uteri 46.00%
N81 Female genital prolapse 37.93%

Documentation Support for Hysterectomy CPT code

For coding Laproscopic hysterectomy, the documentation should state the weight of the uterus before it is sent to pathology. It is a procedure coded based on the size of the uterus and method used to complete the procedure. Below are the list of CPT code used for different hysterectomy exam.

Vaginal: 58260-58294
Laparoscopic-assisted, vaginal (LAVH): 58550-58554
Laparoscopic: 58541-58544, 58570-58573, 58575.

While coding the above CPT codes for hysterectomy, the coders should also check the other services done at the same time along with the main procedure . For example, the total hysterectomy CPT code 58575, the procedure covers lot of other services like tumor debulking, omentectomy ((removal of the omentum, part of the membrane lining the abdominal cavity), and salpingo-oophorectomy (removal of the fallopian tubes and ovaries).

So, the additional procedures performed during the same session- such as salphingo-oophoprectomy, pelvic floor repairs, or mid-urethral slings, are bundled into the hysterectomy code.

So, medical coders should be very careful while reporting the additional procedures along with hysterectomy cpt codes.

Adominal and vaginal hysterectomy (58152,58263-58270, 58292-58294) include pelvic floor repairs to supporting structures that have prolapsed (i.e weakened and “fallen”).

Medical necessity (ICD 10) support for Hysterectomy CPT codes

Best list of list ICD 10 codes will fulfill the medical necessity for hysterectomy CPT codes.

C51-58 Malignant neoplasm of female genital organs

D06 Carcinoma in situ of cervix uteri

D07 Carcinoma in situ of other and unspecified genital organs

N70-77 Inflammatory diseases of female pelvic organs

N80-98 Noninflammatory disorders of female genital tract

N80 Endometriosis

N81 Female genital prolapse

N92 Excessive, frequent and irregular menstruation

N93 Other abnormal uterine and vaginal bleeding

General information about Hysterectomy CPT code 58150, 58180 & 58210

For CPT code 58210

Work RVU/Base Units: 30.91
Non Facility Practice Expense RVU: NA
Facility Practice Expense RVU: 18.39
Professional Liability Insurance RVU: 5.11
Non Facility Total RVU: NA
Facility Total RVU: 54.41
Medicare Non Facility National Payment: NA
Medicare Facility National Payment: $1,843.80
Medicare Status*: A
Medicare Policy Indicators*: C+ M

Global period : 090

For CPT code 58180

Work RVU/Base Units: 16.60
Non Facility Practice Expense RVU: NA
Facility Practice Expense RVU: 9.38
Professional Liability Insurance RVU: 2.75
Non Facility Total RVU: NA
Facility Total RVU: 28.73
Medicare Non Facility National Payment: NA
Medicare Facility National Payment: $973.58
Medicare Status*: A
Medicare Policy Indicators*: C+ M

Global period : 090

For CPT code 58150

Work RVU/Base Units: 17.31
Non Facility Practice Expense RVU: NA
Facility Practice Expense RVU: 10.19
Professional Liability Insurance RVU: 2.86
Non Facility Total RVU: NA
Facility Total RVU: 30.36
Medicare Non Facility National Payment: NA
Medicare Facility National Payment: $1,028.82
Medicare Status*: A
Medicare Policy Indicators*: C+ M