ICD-10-CM Diagnosis Code Z90.711 [convert to ICD-9-CM] Acquired absence of uterus with remaining cervical stump History of hysterectomy, supracervical; History of supracervical hysterectomy; Hx of hysterectomy, supracervical; Status post partial hysterectomy with remaining cervical stump ICD-10-CM Diagnosis Code N99.3 [convert to ICD-9-CM]
The CPT® index, under the main term “hysterectomy,” lists your code choices according to the type of approach documented. This is your first step in selecting the right code.
The surgical approach can be abdominal (the uterus is removed via an incision in the lower abdomen), vaginal (the uterus is removed via an incision in the vagina), or laparoscopic (procedure is performed using a laparoscope, inserted via several small incisions in the body).
With so many code choices, be sure all related procedures are accounted for. Although hysterectomy is a common procedure in gynecology practice, coding for it is a challenge due to so many code choices.
Z90. 710 - Acquired absence of both cervix and uterus | ICD-10-CM.
In a total hysterectomy, the uterus and cervix are removed. In a total hysterectomy with salpingo-oophorectomy, (a) the uterus plus one (unilateral) ovary and fallopian tube are removed; or (b) the uterus plus both (bilateral) ovaries and fallopian tubes are removed.
Listen to pronunciation. (SOO-pruh-SER-vih-kul HIS-teh-REK-toh-mee) Surgery to remove the uterus, but not the cervix. Also called partial hysterectomy and subtotal hysterectomy.
When coding for laparoscopic or robotic procedures, code the standard laparoscopic CPT code, example 58552 for a laparoscopic or robotic vaginal hysterectomy, for uterus 250 g. or less with removal of tube(s) and ovary(s) or as another example 58571 laparoscopic or robot- ic total hysterectomy for uterus 250 g. or less ...
Hysterectomy is a surgery to remove the uterus and cervix. “Abdominal” is the surgical technique that will be used. This means the surgery will be done through an incision in your abdomen. A bilateral salpingo-oophorectomy is surgery to remove both of your ovaries and fallopian tubes.
A salpingo-oophorectomy is the removal of one (unilateral) or both (bilateral) of your ovaries and fallopian tubes. Laparoscopic surgery is a minimally invasive surgery technique that only uses a few small incisions on your lower abdomen.
Total hysterectomy—The uterus and cervix are removed. Supracervical hysterectomy—The upper part of the uterus is removed, but the cervix is left in place.
Laparoscopic Supracervical Hysterectomy (LSH)CPT CodesUterine SizeTubes and/or Ovaries58541≤ 250 gramsNo58542≤ 250 gramsYes58543> 250 gramsNo58544> 250 gramsYes
Overview. This minimally-invasive procedure is used to remove the uterus through small incisions in the abdomen while leaving the cervix and ovaries intact.
The Alphabetic Index main term entry is Hysterectomy, subterms Laparoscopic, total which identifies code 68.41. This code is assigned for the laparoscopic removal of both the cervix and uterus. The Alphabetic Index main term entry is Robotic assisted surgery, subterm Laparoscopic which identifies code 17.42.
Robotic-assisted surgery is considered medically necessary for laparoscopic prostatectomy using the CPT code 55866.
Acquired absence of both cervix and uterus The 2022 edition of ICD-10-CM Z90. 710 became effective on October 1, 2021.
January 16, 2012. Hysterectomy is the surgical removal of the uterus. It is one of the most common surgical procedures among women and is typically considered only after all other treatment options have been tried and failed. • Uterine fibroids (ICD-9-CM category 218): benign tumors of the uterus, which are also called leiomyoma, fibromyoma, ...
UFE may be performed with coils and is classified to code 68.24. The procedure may be performed by injecting other particles into the arteries, such as gelatin sponge, gelfoam, microspheres, polyvinyl alcohol, spherical embolics, or other particulate agent. Assign code 68.25 if the UFE is done without coils.
This open procedure is the most common approach for hysterectomy. • Vaginal: An incision is made in the vagina, and the uterus is removed through the vagina. • Laparoscopic: The hysterectomy is performed using a laparoscope and surgical tools inserted through the several small cuts in the body.
Alternatives to Hysterectomy. The following are potential alternatives to a hysterectomy: • Endometrial ablation for abnormal uterine bleeding (68 .23): laser surgery, which may be done through a hysteroscope, to remove fibroids. A dilation and curettage for endometrial ablation is also classified to code 68.23.
The surgical approach can be abdominal (the uterus is removed via an incision in the lower abdomen), vaginal (the uterus is removed via an incision in the vagina), or laparoscopic (procedure is performed using a laparoscope, inserted via several small incisions in the body).
Radical hysterectomy includes the removal of the entire uterus and nearby tissue, the cervix, and the top part of the vagina. If you know the approach and extent of the procedure, in some cases you may be able to determine the appropriate code without further detail. For example, an abdominal hysterectomy may be:
There are three options: A total hysterectomy is the removal of the whole uterus, the fundus, and cervix. A subtotal, partial, or supracervical hysterectomy is the removal of the fundus or top portion of the uterus only, leaving the cervix in place. Radical hysterectomy includes the removal of the entire uterus and nearby tissue, the cervix, ...
CPT® coding for laparoscopic hysterectomy is based on the size of the uterus and the method used to complete the procedure. Documentation should state the weight of the uterus before it is sent to pathology.
Although hysterectomy is a common procedure in gynecology practice, coding for it is a challenge due to so many code choices. Along with the surgical approach and extent (i.e., total or partial) of the hysterectomy, accounting for related performed procedures is key to code selection.