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Official Description

Laparoscopy, surgical, total hysterectomy for resection of malignancy (tumor debulking), with omentectomy including salpingo-oophorectomy, unilateral or bilateral, when performed

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 58575 refers to a laparoscopic total hysterectomy performed specifically for the resection of malignancy, which includes tumor debulking. This surgical intervention is indicated for patients diagnosed with advanced endometrial cancer or early-stage ovarian cancers. The laparoscopic approach allows for minimally invasive access to the pelvic cavity, which can lead to reduced recovery times and less postoperative pain compared to traditional open surgery. During the procedure, the surgeon utilizes a laparoscope and specialized instruments to remove the uterus, along with any affected fallopian tubes and ovaries, if necessary. An omentectomy, which involves the removal of the omentum (a fold of peritoneum extending from the stomach), is also performed to ensure that any cancerous tissue in that area is excised. The patient is positioned in dorsal lithotomy, and a series of steps are followed to ensure the safe and effective removal of the malignancy while preserving surrounding structures as much as possible. This procedure is critical in managing gynecological cancers and aims to achieve optimal outcomes for the patient.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The laparoscopic total hysterectomy with omentectomy and salpingo-oophorectomy is indicated for the following conditions:

  • End Stage Endometrial Cancer This procedure is performed to manage advanced cases of endometrial cancer where the removal of the uterus and associated structures is necessary to reduce tumor burden.
  • Early Stage Ovarian Cancers It is also indicated for early-stage ovarian cancers, allowing for the removal of the ovaries and fallopian tubes to prevent further spread of malignancy.

2. Procedure

The laparoscopic total hysterectomy procedure begins with the patient positioned in dorsal lithotomy. A urinary catheter is inserted into the bladder to facilitate drainage during the surgery. Following this, a uterine manipulator is introduced into the vagina and secured to the cervix with sutures. This manipulator is crucial as it helps stabilize the uterus and aids in its removal at the end of the procedure. The surgical team then prepares and drapes the abdomen, after which laparoscopic ports are inserted to allow access to the abdominal cavity. The abdomen is insufflated with gas to create a working space for the surgeon.

  • Step 1: The dissection begins on the left side, where connective tissue around the colon is carefully dissected to expose the utero-ovarian and round ligaments. The round ligament is freed from the pelvic wall, and the broad ligament is identified and transected, ensuring the ureter is preserved during this process.
  • Step 2: For a total hysterectomy that includes the removal of the fallopian tubes and ovaries, the infundibulo-pelvic ligament is transected. This step isolates the uterine pedicle, which involves dissecting the posterior aspect of the broad ligament and the peritoneum.
  • Step 3: If the procedure involves sparing the fallopian tube and ovary, the utero-ovarian ligament is transected proximal to the fallopian tube. This step is repeated on the opposite side to ensure complete removal of the necessary structures.
  • Step 4: The omentum is excised starting from the inferior margin of the transverse colon, extending towards the left and up to the lower pole of the spleen. The excision continues towards the right along the transverse colon and hepatic flexure, reaching the inferior border of the pancreas.
  • Step 5: The uterus is mobilized to expose the bottom of the vesico-uterine sac. The peritoneum and connective tissue are dissected to reveal the vesico-vaginal plane. The dissection continues caudally to expose and transect the vesico-uterine ligaments.
  • Step 6: The uterine arteries are clamped and ligated, followed by the ligation of the uterine veins. The pericervical fascia is incised, and the cervico-vaginal vessels along with the uterosacral ligaments are ligated and transected.
  • Step 7: With a vaginal pack in place to maintain pneumoperitoneum and the vaginal manipulator pushed upwards, the vagina is incised and dissected circumferentially. The specimen is then delivered through the vagina.
  • Step 8: Finally, the vagina is closed with sutures from above, hemostasis is confirmed, and the surgical instruments are removed from the abdominal cavity.

3. Post-Procedure

After the completion of the laparoscopic total hysterectomy, patients are typically monitored in a recovery area. Post-procedure care may include pain management, monitoring for any signs of complications, and instructions for activity restrictions. Patients can expect a recovery period that may vary based on individual health factors and the extent of the surgery performed. Follow-up appointments are essential to assess healing and address any concerns that may arise during the recovery phase.

Short Descr LAPS TOT HYST RESJ MAL
Medium Descr LAPS TOT HYSTERECTOMY RESJ MALIGNANCY W/OMNTC
Long Descr Laparoscopy, surgical, total hysterectomy for resection of malignancy (tumor debulking), with omentectomy including salpingo-oophorectomy, unilateral or bilateral, when performed
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) 2 - 150% payment adjustment 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 Inpatient Procedures, not paid under OPPS
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) none
MUE 1

This is a primary code that can be used with these additional add-on codes.

96547 Add On Code MPFS Status: Active Code APC N Intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) procedure, including separate incision(s) and closure, when performed; first 60 minutes (List separately in addition to code for primary procedure)
96548 Add On Code MPFS Status: Active Code APC N Intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) procedure, including separate incision(s) and closure, when performed; each additional 30 minutes (List separately in addition to code for primary procedure)
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
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).
52 Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
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.
79 Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
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).
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
CR Catastrophe/disaster related
GC This service has been performed in part by a resident under the direction of a teaching physician
PD Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days
Q1 Routine clinical service provided in a clinical research study that is in an approved clinical research study
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
Date
Action
Notes
2018-01-01 Added Code Added.
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Description
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