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A total laparoscopic hysterectomy (TLH) is a minimally invasive surgical procedure aimed at removing the uterus, specifically when it weighs more than 250 grams. This procedure is performed using a laparoscope, which is a thin, lighted tube inserted through small incisions in the abdomen. The primary goal of a TLH is to treat various gynecological conditions that may necessitate the removal of the uterus, such as fibroids, abnormal bleeding, or other uterine disorders. The procedure typically involves the removal of the uterus through the vagina; however, if the uterus is too large to be removed intact, it may be morcellized, meaning it is broken down into smaller pieces for easier extraction. Prior to the procedure, a urinary catheter is placed to facilitate bladder management during surgery. The use of laparoscopic techniques allows for reduced recovery time, less postoperative pain, and minimal scarring compared to traditional open hysterectomy methods. The procedure is carefully executed with the aid of various instruments and techniques to ensure the safety and effectiveness of the surgery.
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The total laparoscopic hysterectomy (TLH) is indicated for various conditions related to the uterus, particularly when the uterus is greater than 250 grams. The following are specific indications for performing this procedure:
The procedure for a total laparoscopic hysterectomy involves several critical steps to ensure successful removal of the uterus. The following outlines the procedural steps:
After the total laparoscopic hysterectomy, patients are typically monitored for any immediate complications. Post-procedure care includes managing pain, monitoring for signs of infection, and ensuring proper recovery. Patients may be advised to avoid heavy lifting and strenuous activities for a specified period to promote healing. Follow-up appointments are essential to assess recovery and address any concerns. If the tubes and/or ovaries are also removed during the procedure, additional considerations for hormonal management may be discussed with the patient.
| Short Descr | TLH UTERUS OVER 250 G | Medium Descr | LAPAROSCOPY TOTAL HYSTERECTOMY UTERUS >250 GM | Long Descr | Laparoscopy, surgical, with total 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) | P1E - Major procedure - hysterctomy | 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. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 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). | 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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Notes
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| 2011-01-01 | Changed | Short description changed. |
| 2010-01-01 | Changed | Code description changed. |
| 2008-01-01 | Added | First appearance in code book in 2008. |
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