Hysterectomy Coding Made Simple: Master CPT Nuances for Maximum Reimbursement

Don’t Overlook Common Add-Ons in Hysterectomy Procedures

With nearly 600,000 hysterectomies performed annually in the United States, accurate coding for these high-volume surgeries is essential not only to stay compliant but also to maximize reimbursement. Correct coding depends on several critical factors: the surgical approach, the size or weight of the uterus, and the extent of tissue removed.

But that’s not the whole picture. Ob-gyn surgeons often perform additional procedures such as oophorectomy, salpingectomy, or pelvic floor repairs during the same session. Properly capturing these combined services demands careful review of the operative report and precise documentation.

In this guide, we’ll outline exactly what details to identify, how to select the correct codes, and how to ensure every eligible service is accurately billed.

Surgical Approach: The First Factor in Accurate Hysterectomy Coding

When coding a hysterectomy, the first detail you must clarify is how the surgeon performed the procedure. The approach determines which CPT® code range applies.

• For an open abdominal hysterectomy, use codes 58150–58240.
   
• If the procedure was cancer-related, refer to 58951–58956.
   
• For a vaginal approach, choose from 58260–58294.
   

For laparoscopic techniques, there are additional options:

• Laparoscopic-assisted vaginal hysterectomy (LAVH): 58550–58554
   
• Supracervical laparoscopic hysterectomy: 58541–58544
   
• Total laparoscopic hysterectomy: 58570–58575
   

Uterine Weight: A Key Detail for Correct Code Selection

The next critical factor in hysterectomy coding is the weight of the uterus. CPT codes distinguish procedures based on whether the uterus weighs 250 grams or more. This information is typically found in the pathology report, so be sure to verify it.

• For a uterus weighing 250 grams or less:
   
  • Vaginal hysterectomy: Use 58260–58270
     
  • Laparoscopic hysterectomy: Use 58550–58552 or 58570–58571
     
  • Supracervical laparoscopic hysterectomy: Use 58541–58542
     
• For a uterus weighing more than 250 grams:
   
  • Vaginal approach: Use 58290–58294
     
  • Laparoscopic approach: Use 58553–58554 or 58572–58573
     
  • Supracervical laparoscopic hysterectomy: Use 58543–58544
     

Pro tip: Do not include the weight of separately removed fibroids when calculating the uterus's weight. If fibroids are taken out as an independent specimen, they do not count toward the total uterine weight for coding.

Extent of Removal: Total vs. Subtotal Hysterectomy

Not every hysterectomy is the same. It’s essential to determine how much tissue was removed.

• Was it a total hysterectomy, which includes both the uterus and the cervix?
   
• Or was it a subtotal (supracervical) hysterectomy, where only the uterus was removed, leaving the cervix intact?
   

For example, suppose the surgeon performed a subtotal open hysterectomy. In that case, the appropriate code is usually 58180 – Supracervical abdominal hysterectomy (subtotal hysterectomy), with or without removal of tubes, with or without removal of ovaries.

Always ensure your code accurately reflects the extent of the procedure performed.

Be Careful with Additional Procedures

This is where coding can get tricky. Don’t assume you can bill separately for every extra step.

• If the CPT code already states “with or without removal of tubes and/or ovaries,” you cannot code those removals separately.
   
• The same rule applies to fibroid removal during a hysterectomy; once the uterus is removed, any fibroids go with it, so there’s no separate code.
   

Important: Adding extra codes unnecessarily can lead to claim denials or even audits.

Scenario: Coding a Vaginal Hysterectomy for a Small Uterus

An OBGYN performs a vaginal hysterectomy. The uterus weighs less than 250 grams, and no fallopian tubes or ovaries are removed.

Step-by-Step Coding Logic:

• Approach: Vaginal (CPT range 58260–58294)
• Uterine Weight: ≤250 grams (CPT 58260–58270)
• Extent of Surgery: Only the uterus was removed; cervix removed, but no adnexal structures (tubes/ovaries).

Correct CPT Code: 58260

Vaginal hysterectomy for a uterus weighing 250 grams or less.

Note:

If additional procedures such as an enterocele repair or colpourethrocystopexy had been performed during the same session, you would need to include those codes and possibly adjust the primary hysterectomy code accordingly.

Hysterectomy Combination Claims: How to Code Multiple Procedures Accurately

In OBGYN coding, a hysterectomy is rarely a standalone procedure. Surgeons often address multiple pelvic conditions in the same session, making it crucial to capture every component of the surgery accurately.

From stress urinary incontinence repairs to cancer staging procedures, knowing when and how to report these combination surgeries can significantly impact reimbursement and compliance.

Hysterectomy with Stress Incontinence Repair: Key Fixation Terms You Must Know

When an OBGYN performs a bladder or urethral suspension during a hysterectomy, pay close attention to terms like Marshall-Marchetti-Krantz, Burch, or Pereyra. These are not just surgical references; they signal the correct combination code you’ll need.

• Abdominal approach? Use 58152
• Total abdominal hysterectomy (corpus and cervix), with or without removal of tubes and/or ovaries, with colpo-urethrocystopexy (e.g., Marshall-Marchetti-Krantz, Burch).
• Vaginal approach? Choose 58267
• Vaginal hysterectomy for uterus 250 g or less, with colpo-urethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type), with or without endoscopic control.

Pro Tip: If the operative note mentions a “bladder lift” or “urethral support,” review the documentation carefully for these fixation terms, as they are your key to selecting the correct code.

Hysterectomy with Vaginectomy: A Different Coding Territory

When an OBGYN removes part or all of the vagina during a hysterectomy, often due to malignancy, you enter a more complex coding zone.

• Open procedure with cancer staging:
• Use 58200
• Total abdominal hysterectomy including partial vaginectomy, with para-aortic and pelvic lymph node sampling, with or without removal of tubes and/or ovaries.
• Radical open procedure:
• Report 58210
• Radical abdominal hysterectomy with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy), with or without removal of tubes and/or ovaries.
• Laparoscopic radical procedure:
• Use 58548
• Laparoscopy, surgical, with radical hysterectomy, including bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy), with removal of tubes and/or ovaries if performed.
• Vaginal route options:
  • 58275: Vaginal hysterectomy with total or partial vaginectomy
  • 58280: Vaginal hysterectomy with partial/total vaginectomy plus enterocele repair
  • 58285: Vaginal hysterectomy, radical (Schauta type operation)

Remember: Radical hysterectomies involve the removal of parametrial tissue and the upper third of the vagina. Always confirm this is documented before selecting these codes.

Hysterectomy with Lymph Node Sampling: Specificity is Key

When cancer is involved, lymph node sampling is often required, but not every surgical approach includes it.

• Modified radical abdominal hysterectomy with partial vaginectomy and node sampling: Code 58200
• Complete bilateral pelvic and para-aortic lymphadenectomy via open surgery: Code 58210
• Laparoscopic approach: Code 58548

If you miss coding lymph node biopsies, you risk undercoding an essential cancer staging procedure.

Cancer Cases: The Four Power Codes You Must Know

When ovarian or uterine cancer is the primary concern and the procedure involves complete staging and debulking, these codes become essential:

• 58951
• Initial resection of ovarian, tubal, or primary peritoneal malignancy with bilateral salpingo-oophorectomy and omentectomy; includes total abdominal hysterectomy, pelvic, and limited para-aortic lymphadenectomy.
• 58953/58954
• Bilateral salpingo-oophorectomy with omentectomy, total abdominal hysterectomy, and radical dissection for debulking with or without extended lymph node dissection.
• 58956
• Bilateral salpingo-oophorectomy with total omentectomy and total abdominal hysterectomy for malignancy.

Coding Tip: Always cross-check the pathology report and operative notes to verify precisely what was performed. These cancer-related codes are particular and powerful but can easily be misused if documentation is incomplete.

Don’t Miss Enterocele Repairs During Hysterectomies

Enterocele repairs are commonly performed during hysterectomies, especially when done via the vaginal approach. The good news? There are specific combination codes that capture both services together:

• 58263
• Vaginal hysterectomy for uterus 250 g or less, with removal of tubes and/or ovaries, plus enterocele repair.
• 58270
• Vaginal hysterectomy for uterus 250 g or less, with enterocele repair.
• 58280
• Vaginal hysterectomy with total or partial vaginectomy, plus enterocele repair.
• 58292/58294
• Vaginal hysterectomy for uterus greater than 250 g, including enterocele repair for larger uteri.

Important: There is no combination code for a vaginal hysterectomy with an abdominal enterocele repair; those would need to be reported separately.

Accurate Hysterectomy Coding Made Simple with BillingFreedom

When it comes to complex OBGYN medical billing procedures, such as hysterectomies with multiple add-on repairs, BillingFreedom ensures that every code is correct the first time. Our certified coders don't rely on guesswork; they apply proven, approved coding guidelines to secure accurate, compliant, and optimized reimbursement for your practice.

We understand that combination procedures such as hysterectomy with enterocele repairs, lymph node sampling, vaginectomy, or colpourethrocystopexy can easily lead to coding confusion. With BillingFreedom, you never have to worry about missed charges or denials. Our team is well-versed in these scenarios and ensures that your claims are coded to perfection.

Let's look at how we handle a real-world case with precision.

A Real Scenario: How BillingFreedom Gets It Right

Here's a situation that often challenges practices but is routine for our team:

Scenario:

An OBGYN performs a vaginal hysterectomy (uterus ≤250 g), an enterocele repair, and a colpourethrocystopexy for stress incontinence, all in the same session.

Many practices are unsure how to code this combination, but there are two correct approaches, and selecting the right one impacts reimbursement.

Option 1

• 58270 – Vaginal hysterectomy with enterocele repair
• 51840 – Simple anterior vesicourethropexy or urethropexy (e.g., Marshall-Marchetti-Krantz, Burch)

Total RVUs: 26.92 + 20.90 = 47.82

Option 2

• 58267 – Vaginal hysterectomy with colpourethrocystopexy
• 57268 – Repair of enterocele, vaginal approach (separate procedure)

Total RVUs: 32.16 + 15.30 = 47.46

The best choice? BillingFreedom selects Option 1 because it provides slightly higher RVUs and is fully compliant with National Correct Coding Initiative (NCCI) guidelines when supported by proper documentation.

Why Practices Trust BillingFreedom

• Deep OBGYN coding expertise – We know every fixation term, surgical cue, and CPT detail.
• Scenario-based accuracy – We ensure every procedure is coded correctly to maximize reimbursement.
• Compliance-focused process – Protect your practice from denials, downcoding, and audits.
• Proven results – Fewer delays, more clean claims, and optimized revenue.

For us, even the most complex hysterectomy cases, whether they include enterocele repairs, vaginectomies, or lymph node sampling for cancer staging, are handled with precision and confidence.

Let BillingFreedom Be Your Coding Advantage

Don't let complex OBGYN billing slow down your practice or cost you revenue. With BillingFreedom, you get more than just billing support; you get a team that knows exactly how to code and bill for even the most advanced procedures.

Take the stress out of hysterectomy coding. Let BillingFreedom simplify your claims and ensure you're paid what you deserve.

For more details about our exceptional OB/GYN billing services, please don't hesitate to contact us via email at info@billingfreedom.com or call us at +1 (855) 415-3472. 

Your financial tranquility is our priority!