A Guide to CPT Code for Myomectomy

There are different approaches to performing a myomectomy, depending on the size, number, and location of the fibroids. The most common approaches are abdominal, vaginal, and laparoscopic. Each approach has its advantages and disadvantages, as well as its own set of CPT codes.

CPT codes are standardized codes that describe medical procedures and services. They are used by healthcare providers and payers to communicate and document the services performed and to determine reimbursement rates. In this guide, we will explain the CPT codes for myomectomy based on the different approaches and factors.

Abdominal Myomectomy

Abdominal myomectomy is a type of open surgery that involves making an incision in the abdomen to access and remove the fibroids from the uterus. This approach is suitable for large, multiple, or deep-seated fibroids that cannot be removed by other methods. Abdominal myomectomy has a longer recovery time and a higher risk of complications than other approaches, but it also allows for more thorough removal of fibroids.

The CPT codes for abdominal myomectomy are:

• 58140: Myomectomy, excision of fibroid tumor(s) of the uterus, 1 to 4 intramural myoma(s) with a total weight of 250 g or less and/or removal of surface myomas; abdominal approach
  58146: Myomectomy, excision of fibroid tumor(s) of the uterus, 5 or more intramural myomas and/or intramural myomas with total weight greater than 250 g, abdominal approach

These codes differentiate between the number of intramural myomas (58140 for one to four; 58146 for five or more) and the total weight of intramural myomas (58140 for a total weight of 250 grams or less; 58146 for total weight greater than 250 grams). Intramural myomas are fibroids that are located within the wall of the uterus and can vary in size from microscopic to larger than a grapefruit. Surface myomas are fibroids that are located on the outer surface of the uterus and are usually easier to remove than intramural ones.

Vaginal Myomectomy

Vaginal myomectomy is a type of minimally invasive surgery that involves making an incision in the vagina to access and remove the fibroids from the uterus. This approach is suitable for small or pedunculated fibroids that protrude into the uterine cavity or the vaginal canal. Pedunculated fibroids are fibroids that are attached to the uterus by a stalk. Vaginal myomectomy has a shorter recovery time and a lower risk of complications than abdominal myomectomy, but it also has limited access and visibility to remove fibroids.

The CPT code for vaginal myomectomy is:

58145: Myomectomy, excision of fibroid tumor(s) of uterus; vaginal approach

This code covers any number or weight of fibroids that are removed vaginally.

Laparoscopic Myomectomy

Laparoscopic myomectomy is a type of minimally invasive surgery that involves making small incisions in the abdomen to insert a laparoscope (a thin tube with a camera and light) and surgical instruments to access and remove the fibroids from the uterus. This approach is suitable for small or medium-sized fibroids that are located on the outer surface or within the wall of the uterus. Laparoscopic myomectomy has a shorter recovery time and a lower risk of complications than abdominal myomectomy, but it also requires more skill and experience from the surgeon and may not be able to remove all fibroids.

The CPT codes for laparoscopic myomectomy are:

• 58541: Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy), unilateral or bilateral
• 58542: Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy), unilateral or bilateral, with removal of tube(s) and/or ovary(s) from opposite side
• 58543: Laparoscopy, surgical; with total hysterectomy, for uterus 250 g or less
• 58544: Laparoscopy, surgical; with total hysterectomy, for uterus greater than 250 g
• 58545: Laparoscopy, surgical; with myomectomy, excision of 1 to 4 intramural myoma(s) with total weight of 250 g or less and/or removal of surface myoma(s)
• 58546: Laparoscopy, surgical; with myomectomy, excision of 5 or more intramural myoma(s) and/or intramural myoma(s) with total weight greater than 250 g

Risks of myomectomy

Myomectomy is a safe procedure, but it does have some risks. These risks include:

• Bleeding
• Infection
• Scarring
• Damage to nearby organs
• Adhesions
• Infertility

Recovery from myomectomy

Recovery from a myomectomy usually takes several weeks. During this time, you may experience pain, bleeding, and fatigue. You will need to take it easy and avoid strenuous activity. Your doctor will give you specific instructions on how to care for yourself after your surgery.

Insurance coverage for myomectomy

Insurance coverage for myomectomy varies depending on your insurance plan. Some plans will cover the cost of a myomectomy if it is performed to relieve symptoms caused by fibroids. Other plans may only cover the cost of myomectomy if it is performed to remove fibroids that are large or growing rapidly.

You should contact your insurance company to find out if your plan covers myomectomy and how much of the cost your plan will pay.

Conclusion

Myomectomy is a safe and effective treatment for women with fibroids. It can relieve symptoms caused by fibroids and improve a woman’s quality of life. If you are considering myomectomy, talk to your doctor about the risks and benefits of the procedure.

FAQs

What are uterine fibroids?

Uterine fibroids are benign (noncancerous) tumors that grow in the uterus. They are very common, affecting up to 80% of women by the age of 50. Fibroids can be small or large, and they can grow in different places in the uterus.

What are the symptoms of uterine fibroids?

The symptoms of uterine fibroids can vary depending on the size, location, and number of fibroids. Some common symptoms include:

• Heavy menstrual bleeding
• Pelvic pain
• Painful intercourse
• Frequent urination
• Constipation
• Infertility

What are the treatment options for uterine fibroids?

The treatment for uterine fibroids depends on the size, location, and number of fibroids, as well as the woman’s symptoms. Some treatment options include:

• Medication
• Surgery

What is myomectomy?

Myomectomy is a surgical procedure to remove uterine fibroids. It is a safe and effective treatment for women with fibroids who want to preserve their fertility. Myomectomy can be performed through a laparotomy (open surgery) or laparoscopy (keyhole surgery).

What are the risks of myomectomy?

The risks of myomectomy are similar to the risks of any surgery. These risks include:

• Bleeding
• Infection
• Scarring
• Damage to nearby organs
• Adhesions
• Infertility

How long does recovery from a myomectomy take?

Recovery from a myomectomy usually takes several weeks. During this time, you may experience pain, bleeding, and fatigue. You will need to take it easy and avoid strenuous activity. Your doctor will give you specific instructions on how to care for yourself after your surgery.

What is the cost of a myomectomy?

The cost of a myomectomy varies depending on the type of surgery, the location of the surgery, and the surgeon’s fees. You should contact your insurance company to find out if your plan covers myomectomy and how much of the cost your plan will pay.

What are the alternatives to myomectomy?

There are several alternatives to myomectomy for the treatment of uterine fibroids. These alternatives include:

• Medication
• Uterine artery embolization (UAE)
• MRI-guided focused ultrasound (MRgFUS)
• Hysterectomy

What is the best treatment for uterine fibroids?

The best treatment for uterine fibroids depends on the individual woman’s needs and preferences. Your doctor can help you decide which treatment is right for you.