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A conization of the cervix is a surgical procedure that involves the removal of a cone-shaped section of cervical tissue. This procedure can be performed with or without additional techniques such as fulguration, dilation and curettage, and repair. The conization can be executed using different methods, including cold knife excision or laser techniques, specifically through loop electrode excision. The primary goal of this procedure is to obtain a tissue sample for diagnostic purposes, particularly when there are abnormal cervical cells detected during a Pap smear or other examinations. The conization allows for the evaluation of the transformation zone, which is the area of the cervix where most cervical cancers begin. By excising this tissue, healthcare providers can assess the presence of precancerous changes or cancer itself, thereby guiding further treatment options. The procedure is typically performed under local anesthesia, and the choice of technique may depend on the specific clinical scenario, the extent of the abnormality, and the patient's overall health status.
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Conization of the cervix is indicated for several specific conditions and symptoms, including:
The conization procedure involves several detailed steps to ensure the effective removal of cervical tissue. First, the patient is positioned appropriately, and a weighted speculum is inserted into the vagina to provide visibility and access to the cervix. In some cases, cervical cerclage may be performed to control any bleeding that may occur during the procedure. The cervix is then sounded to assess its length and the position of the internal os, which is crucial for determining the extent of the conization. Following this, the cervix is painted with Lugol solution, which helps to delineate the abnormal tissue. Lateral traction is applied to the cerclage sutures to stabilize the cervix during the excision. A cone or wedge-shaped section of cervical tissue is then excised using either a cold knife or laser technique. In the case of cold knife conization, a blade is used to remove the tissue, ensuring that the entire transformation zone and a 2-3 mm margin of healthy tissue are included in the excised specimen. If laser conization is chosen, bleeding is managed through cervical cerclage or local injection of a vasoconstrictor. The laser is used to create small dots on the exocervical margin, which are then connected to form the incision. The depth of the incision is carefully controlled, and the cone specimen is ideally removed in one piece. After the cone excision, the endocervical canal may be dilated, and any remaining cervical tissue can be removed through curettage as necessary. If excessive bleeding occurs, it is controlled through cautery or fulguration. Finally, if required, suture repair is performed using figure-eight or U sutures to ensure proper healing. In the case of loop electrode excision (CPT® Code 57522), the procedure involves the use of an insulated speculum and a grounding pad for the patient. A local anesthetic with a vasoconstrictor is injected into the cervical epithelium to minimize discomfort. An appropriately sized electrical loop is selected, and cervical tissue is excised to a depth of approximately 1 cm on the first pass. Additional passes are made until the entire transformation zone and a margin of healthy tissue are excised. Similar to the cold knife method, fulguration, dilation and curettage, and cervical repair are performed as needed.
After the conization procedure, patients are typically monitored for any immediate complications, such as excessive bleeding or infection. It is common for patients to experience some cramping and light bleeding following the procedure, which may last for several days. Patients are advised to avoid sexual intercourse, tampons, and douching for a specified period to promote healing and reduce the risk of infection. Follow-up appointments are essential to assess the healing process and to discuss the pathology results of the excised tissue. Depending on the findings, further treatment or monitoring may be necessary. Patients should be informed about signs of complications, such as heavy bleeding, fever, or unusual discharge, and instructed to seek medical attention if these occur.
| Short Descr | CONIZATION OF CERVIX | Medium Descr | CONIZATION CERVIX W/WO D&C RPR ELTRD EXC | Long Descr | Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; loop electrode excision | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5E - Ambulatory procedures - other | MUE | 1 | CCS Clinical Classification | 125 - Other excision of cervix and uterus |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | AG | Primary physician | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CR | Catastrophe/disaster related | GA | Waiver of liability statement issued as required by payer policy, individual case | GC | This service has been performed in part by a resident under the direction of a teaching physician | PO | Excepted service provided at an off-campus, outpatient, provider-based department of a hospital | SG | Ambulatory surgical center (asc) facility service | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2013-01-01 | Changed | Medium Descriptor changed. |
| 1995-01-01 | Added | First appearance in code book in 1995. |
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