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Myomectomy is a surgical procedure aimed at the excision of fibroid tumors from the uterus. These fibroids, also known as leiomyomas, are benign tumors that develop from the muscle tissue of the uterus, specifically the myometrium. They can vary in location, being classified as submucous, intramural, subserous, or pedunculated. Submucous fibroids extend into the uterine cavity and are typically addressed through hysteroscopy. Intramural fibroids are embedded within the uterine muscle, while subserous fibroids are located on the outer surface of the uterus and may be attached by a thin stalk, known as pedunculation. The procedure described by CPT® Code 58145 specifically refers to a vaginal myomectomy, which involves the removal of one to four intramural myomas that weigh a total of 250 grams or less, as well as the removal of surface myomas. The surgical approach can be anterior or posterior, and it involves incising the vaginal mucosa, exposing the peritoneum, and carefully dissecting the fibroids from the uterine wall. This procedure is essential for alleviating symptoms associated with fibroids, such as pelvic pain, heavy menstrual bleeding, and pressure symptoms, while preserving the uterus for future reproductive potential.
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The myomectomy procedure described by CPT® Code 58145 is indicated for the following conditions:
The myomectomy procedure involves several detailed steps to ensure the effective removal of fibroids while preserving the integrity of the uterus. The procedure begins with the selection of either an anterior or posterior vaginal approach. The vaginal mucosa is incised, and the incision is extended through the fascia to expose the peritoneum. If a posterior approach is chosen, a long narrow retractor is placed in the Douglas pouch, and a second retractor is positioned on the posterior wall of the cervix to facilitate exposure of the posterior uterine wall. In contrast, during an anterior approach, the ureters must be identified, and the pillars are clamped and cut, with a stitch placed in the stump of each pillar for later reconstruction. Following this, the vesicouterine space is dissected to expose the anterior uterine wall. The surgeon then performs digital palpation of the uterus to determine the location, number, and size of the fibroids. For subserous or pedunculated fibroids, they are removed from the exterior surface of the uterus. In the case of intramural fibroids, the first fibroid is grasped, and the uterine wall is incised down to the level of the fibroid. The fibroid capsule is then exposed and carefully dissected. The fibroid is enucleated and removed, and this process is repeated for each fibroid until all have been excised. Finally, the uterine wall and serosa are reconstructed in layers to ensure proper healing and restoration of uterine integrity.
Post-procedure care following a vaginal myomectomy includes monitoring for any signs of complications such as excessive bleeding or infection. Patients are typically advised to rest and may be prescribed pain management medications to alleviate discomfort. Follow-up appointments are essential to assess the healing process and ensure that the uterus is recovering appropriately. Patients may also receive guidance on activity restrictions, particularly regarding heavy lifting or strenuous exercise, to promote optimal recovery. The expected recovery time can vary, but many patients can return to normal activities within a few weeks, depending on individual healing and the extent of the procedure.
| Short Descr | MYOMECTOMY VAG METHOD | Medium Descr | MYOMECTOMY 1-4 MYOMAS 250 GM/< VAGINAL APPR | Long Descr | Myomectomy, excision of fibroid tumor(s) of uterus, 1 to 4 intramural myoma(s) with total weight of 250 g or less and/or removal of surface myomas; vaginal 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 | 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) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 125 - Other excision of cervix and uterus |
| 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). | 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. | 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 | CR | Catastrophe/disaster related | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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| 2007-01-01 | Changed | Code description changed. |
| 2003-01-01 | Changed | Code description changed. |
| 2002-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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