CPT® Code 58152

Official Description

Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s); with colpo-urethrocystopexy (eg, Marshall-Marchetti-Krantz, Burch)

Common Language Description

The CPT® Code 58152 refers to a surgical procedure known as a total abdominal hysterectomy, which involves the complete removal of the uterus, including both the corpus and cervix. This procedure may also include the optional removal of the fallopian tubes and/or ovaries. The surgery is performed through an incision made in the abdomen, allowing the surgeon to access the anterior surface of the uterus. During the operation, the peritoneum at the cervicovesical fold is incised, and blunt dissection is utilized to expose the broad ligament, round ligament, and fallopian tubes. If the decision is made to remove the fallopian tubes and/or ovaries, the surgeon makes an incision in the broad ligament to visualize and ligate the ovarian vessels. The procedure continues with the careful dissection of the fallopian tubes and ovaries from surrounding tissues, followed by the clamping and division of the round ligaments and blood vessels. The cervix is palpated to ascertain the position of the bladder, which is then dissected off the uterus down to the vaginal wall. The posterior aspect of the uterus is inspected to ensure there are no adhesions to the rectum. The uterine vessels are clamped, divided, and ligated, and the posterior cervical peritoneum is incised, extending around the cervix. The vaginal wall is then incised, allowing for the separation of the cervix from the vagina. The uterus and cervix, along with any removed tubes and ovaries, are extracted, and the vaginal opening is subsequently closed. The surgical site is inspected for bleeding, which is controlled before the abdominal incision is closed. In addition to the hysterectomy, this procedure includes a colpo-urethrocystopexy, which is a surgical technique used to suspend the prolapsed vaginal wall and urethra. This is achieved by placing sutures through the paravaginal fascia at the urethrovesical junction, which are then anchored to the Cooper's ligament, pelvic fascia, or pubic bone to provide necessary support to the bladder and urethra. If further suspension is needed, additional sutures may be placed along the base of the bladder to ensure proper support and stability.

1. Indications

The total abdominal hysterectomy with colpo-urethrocystopexy, as described by CPT® Code 58152, is indicated for various medical conditions that may necessitate the removal of the uterus, cervix, and potentially the fallopian tubes and ovaries. The following are common indications for this procedure:

Uterine Fibroids: Benign tumors that can cause pain, heavy bleeding, or other complications.
Endometriosis: A condition where tissue similar to the lining of the uterus grows outside the uterus, leading to pain and other issues.
Uterine Prolapse: A condition where the uterus descends into the vaginal canal, which may require surgical intervention for correction.
Abnormal Uterine Bleeding: Heavy or irregular bleeding that does not respond to other treatments may necessitate a hysterectomy.
Gynecologic Cancer: Malignancies affecting the uterus, cervix, or surrounding structures may require a total abdominal hysterectomy as part of the treatment plan.

2. Procedure

The procedure for a total abdominal hysterectomy with colpo-urethrocystopexy involves several detailed steps, as outlined below:

Step 1: The surgeon begins by making an incision in the abdomen to access the uterus. This incision allows for the exposure of the anterior surface of the uterus.
Step 2: The peritoneum at the cervicovesical fold is incised to facilitate access to the surrounding structures.
Step 3: Blunt dissection is performed to expose the broad ligament, round ligament, and fallopian tubes, which are critical anatomical landmarks during the procedure.
Step 4: If the fallopian tubes and/or ovaries are to be removed, an incision is made in the broad ligament to visualize the ovarian vessels, which are then suture ligated to prevent bleeding.
Step 5: The cut edges of the broad ligament are plicated with mattress sutures to secure the area and prevent complications.
Step 6: The fallopian tubes and ovaries are carefully dissected free from surrounding tissues, ensuring minimal damage to adjacent structures.
Step 7: The round ligaments are clamped and divided, and the associated blood vessels are suture ligated bilaterally to control blood flow.
Step 8: The cervix is palpated to ascertain the position of the bladder, which is then dissected off the uterus down to the vaginal wall.
Step 9: The posterior aspect of the uterus is inspected to confirm that it is not adhered to the rectum, which is crucial for preventing complications.
Step 10: The uterine vessels are exposed, clamped, divided, and suture ligated to facilitate the removal of the uterus.
Step 11: The posterior cervical peritoneum is incised, and the incision is extended around the cervix to allow for complete removal.
Step 12: The vaginal wall is incised, and the cervix is separated from the vagina, completing the removal of the uterus and cervix.
Step 13: The uterus and cervix, along with any removed tubes and ovaries, are extracted from the abdominal cavity.
Step 14: The vaginal opening is closed, and the surgical site is inspected for any bleeding, which is controlled as necessary.
Step 15: Finally, the abdominal incision is closed, completing the surgical procedure.
Step 16: Following the hysterectomy, the colpo-urethrocystopexy is performed, where two sutures are placed through the paravaginal fascia at the urethrovesical junction, oriented perpendicular to the vaginal axis.
Step 17: These sutures are then passed through the Cooper's ligament, pelvic fascia, or pubic bone and tied to provide suspension and support to the bladder and urethra.
Step 18: If additional suspension is required, a second set of sutures may be placed along the base of the bladder to ensure adequate support.

3. Post-Procedure

After the completion of the total abdominal hysterectomy with colpo-urethrocystopexy, patients typically require monitoring for any immediate postoperative complications. Expected recovery includes managing pain, monitoring for signs of infection, and ensuring proper healing of the surgical site. Patients may be advised on activity restrictions, including avoiding heavy lifting and strenuous exercise for a specified period. Follow-up appointments are essential to assess recovery progress and address any concerns that may arise during the healing process. Additionally, patients may receive guidance on managing any hormonal changes if the ovaries were removed during the procedure.

Short Descr	TOTAL HYSTERECTOMY
Medium Descr	TOT ABD HYST W/WO RMVL TUBE OVARY W/COLPURETHRXY
Long Descr	Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s); with colpo-urethrocystopexy (eg, Marshall-Marchetti-Krantz, Burch)
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)	P1E - Major procedure - hysterctomy
MUE	1
CCS Clinical Classification	124 - Hysterectomy, abdominal and vaginal

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).
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