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Laparoscopic supracervical hysterectomy (LSH) is a minimally invasive surgical procedure designed to remove the uterus while preserving the cervix. This approach serves as an alternative to the more traditional total abdominal hysterectomy. One of the key advantages of LSH is that it maintains better pelvic support, as the ligaments that support the vagina and cervix remain intact. This preservation is significant for patients, as it can help maintain sexual function by keeping the cervix and its associated secretory glands. It is important to note that LSH is not indicated for patients with cancer or those who have a history of precancerous cervical conditions. During the procedure, a retractor is inserted vaginally into the cervix to facilitate visualization and manipulation of the uterus. The surgical process involves making a small incision at the belly button and two additional small incisions near the hip bones to accommodate laparoscopic instruments. The abdomen is inflated with carbon dioxide gas to create a working space for the surgeon. A laparoscope is introduced through the belly button incision, while cutting and grasping instruments, along with the retractor, are utilized through the other incisions. The uterus, either alone or in conjunction with the fallopian tubes and/or ovaries, is carefully separated from its blood supply and detached from the cervix. To enhance support and reduce the risk of future prolapse, permanent sutures are placed in the ligaments that support the cervix. The center of the cervix is then coagulated to minimize bleeding, and the cervix is covered with peritoneum, the abdominal lining. Following this, a morcellator—a specialized instrument with a rounded blade—is used to deliver the uterus, either with or without the tubes and/or ovaries, in strips for pathological examination. After addressing any bleeding points, the instruments are removed, and the carbon dioxide gas is evacuated from the abdomen before the incisions are closed.
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The laparoscopic supracervical hysterectomy (LSH) is indicated for patients who require the removal of the uterus but do not have a history of cancer or precancerous cervical pathology. The following conditions may warrant the performance of this procedure:
The laparoscopic supracervical hysterectomy involves several key procedural steps that ensure the safe and effective removal of the uterus. The procedure begins with the patient being placed under general anesthesia. Following this, a small incision is made at the belly button, and two additional small incisions are created in the area of the hip bones. These incisions allow for the insertion of laparoscopic instruments. The abdomen is then inflated with carbon dioxide gas to create a working space for the surgeon. A laparoscope, which is a thin tube with a camera, is inserted through the belly button incision to provide visualization of the surgical field.
After the laparoscopic supracervical hysterectomy, patients can expect a recovery period that typically involves monitoring for any complications such as bleeding or infection. Pain management is an important aspect of post-operative care, and patients may be prescribed pain relief medications. It is common for patients to experience some discomfort and fatigue following the procedure. Most patients are encouraged to gradually resume normal activities, but heavy lifting and strenuous exercise should be avoided for a specified period as advised by the healthcare provider. Follow-up appointments are essential to ensure proper healing and to address any concerns that may arise during the recovery process.
| Short Descr | LSH UTERUS ABOVE 250 G | Medium Descr | LAPS SUPRACERVICAL HYSTERECTOMY >250 | Long Descr | Laparoscopy, surgical, supracervical hysterectomy, for uterus greater than 250 g; | 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) | 2 - Co-surgeons permitted and no documentation required if the two- specialty requirement is met. | 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 | Non office-based surgical procedure added in CY 2008 or later; 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 | 124 - Hysterectomy, abdominal and vaginal |
This is a primary code that can be used with these additional add-on codes.
| 49327 | Addon Code MPFS Status: Active Code APC N ASC N1 Laparoscopy, surgical; with placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), intra-abdominal, intrapelvic, and/or retroperitoneum, including imaging guidance, if performed, single or multiple (List separately in addition to code for primary procedure) |
| 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). | 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). | GC | This service has been performed in part by a resident under the direction of a teaching physician | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 2010-01-01 | Changed | Code description changed. |
| 2007-01-01 | Added | First appearance in code book in 2007. |
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