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The procedure described by CPT® Code 57540 involves the excision of the cervical stump through an abdominal approach. This surgical intervention is typically indicated for patients who have previously undergone a subtotal abdominal hysterectomy and are now facing complications such as cervical neoplasm or myoma. The term "cervical stump" refers to the remaining portion of the cervix that may persist after a hysterectomy. The excision is performed to remove this tissue, which may be necessary for addressing pathological conditions that arise in the cervical area. The procedure requires careful dissection and manipulation of surrounding anatomical structures, including the bladder and ligaments, to ensure complete removal of the cervical stump while preserving adjacent organs and tissues. The abdominal approach allows for direct access to the pelvic cavity, facilitating the excision and subsequent closure of the surgical site in a controlled manner.
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The excision of the cervical stump via an abdominal approach is indicated for specific conditions that may arise following a subtotal abdominal hysterectomy. These indications include:
The procedure for excising the cervical stump through an abdominal approach involves several detailed steps, each critical to the successful removal of the cervical tissue. The process begins with an incision in the lower abdomen, which is carefully made to reach the rectus abdominis muscles. These muscles are separated along the midline to provide access to the peritoneal cavity. Once the peritoneum is elevated and opened, the surgeon identifies and elevates the round ligaments, which are then suture ligated to prevent excessive bleeding during the procedure.
Next, the bladder is meticulously freed from the cervix to ensure that no damage occurs to this organ during the excision. The cervical stump is then elevated, and the broad ligament is identified. The surgeon incises the bladder peritoneum, the posterior leaf of the broad ligament, and the peritoneum overlying the cul-de-sac and rectum to gain further access to the cervical stump. Any attachments between the bladder and the cervix are carefully dissected using both blunt and sharp dissection techniques.
Following this, the infundibulopelvic ligament is clamped and transected, allowing for the cervical stump to be freed from both the round and infundibulopelvic ligaments. The peritoneum surrounding the cervical stump is opened, and traction is applied to facilitate its removal. The cardinal and uterosacral ligaments are then ligated and divided, leading to the complete excision of the cervical stump.
After the cervical stump is removed, the vaginal cuff is suspended to ensure proper healing and support. The space between the rectum and vagina is closed with sutures, and the edge of the vagina is repaired with additional sutures. Finally, the angle of the vagina is attached to the uterosacral and cardinal ligaments to restore anatomical integrity. The abdominal incision is then closed in layers to promote optimal healing.
Post-procedure care following the excision of the cervical stump includes monitoring for any signs of complications such as infection or excessive bleeding. Patients may be advised to follow specific guidelines regarding activity levels and wound care to ensure proper healing. Follow-up appointments are typically scheduled to assess recovery and address any concerns that may arise during the healing process.
| Short Descr | REMOVAL OF RESIDUAL CERVIX | Medium Descr | EXCISION CERVICAL STUMP ABDOMINAL APPROACH | Long Descr | Excision of cervical stump, abdominal approach; | 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) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - 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). | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AG | Primary physician | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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| 2010-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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