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Myomectomy is a surgical procedure aimed at the excision of fibroid tumors from the uterus. Uterine fibroids, also known as leiomyomas, are benign tumors that develop from the muscle tissue of the uterus, specifically the myometrium. These tumors can vary in location and type, including submucous, intramural, subserous, and pedunculated fibroids. Submucous fibroids extend into the uterine cavity and are typically addressed through hysteroscopic techniques. 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 58146 specifically refers to the abdominal approach for the removal of five or more intramural myomas or for myomas that collectively weigh more than 250 grams. During this procedure, an incision is made in the abdomen to access the uterus, which is then inspected and palpated to locate the fibroids. If the fibroids are intramural, the surgeon incises the uterus to reach the fibroid, which is then carefully removed from the uterine wall. The use of electrocautery helps control any bleeding during the excision. After the fibroids are removed, the uterus is sutured back together in layers to ensure proper healing. This procedure is essential for patients experiencing significant symptoms due to the presence of multiple fibroids, such as heavy menstrual bleeding, pelvic pain, or pressure symptoms, and aims to alleviate these issues while preserving the uterus.
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The myomectomy procedure described by CPT® Code 58146 is indicated for patients presenting with the following conditions:
The procedure for myomectomy under CPT® Code 58146 involves several critical steps to ensure the effective removal of fibroid tumors:
Post-procedure care following a myomectomy under CPT® Code 58146 includes monitoring for any complications such as 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 healing and ensure that there are no complications. Patients may also receive guidance on activity restrictions and signs to watch for that may indicate complications. The expected recovery time can vary, but many patients can return to normal activities within a few weeks, depending on their individual circumstances and the extent of the surgery.
| Short Descr | MYOMECTOMY ABDOM COMPLEX | Medium Descr | MYOMECTOMY 5/> MYOMAS &/>250 GM ABDOMINA | Long Descr | Myomectomy, excision of fibroid tumor(s) of uterus, 5 or more intramural myomas and/or intramural myomas with total weight greater than 250 g, 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). | 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 | 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. |
| 2007-01-01 | Changed | Code description changed. |
| 2003-01-01 | Added | First appearance in code book in 2003. |
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