COEMIG Qualifying Procedures with CPT Codes

Surgeon of Excellence in Minimally Invasive Surgery-Gynecology Qualifying Procedures with CPT Codes?

All cases must have been performed laparoscopically or been laparoscopy-assisted for any of these CPT codes to qualify.

Laparoscopic Procedures

CPT Code

Description

38500 Biopsy or excision of lymph node(s)

38562 Limited lymphadenectomy for staging (separate procedure); pelvic or para-aortic

38564

Limited lymphadenectomy for staging (separate procedure); retroperitoneal (aortic and/or splenic)

Laparoscopy, surgical, appendectomy - for this procedure to qualify, an exploratory

44970 laparoscopy must have been performed on a patient who presented with abdominal pain and

whose appendix was removed after ruling out gynecologic conditions

Excision or destruction, intra-abdominal tumors, cysts or endometriomas, 1 or more

49205 peritoneal, mesenteric, or retroperitoneal primary or secondary tumors; largest tumor greater

than 10.0 cm diameter 51990 Laparoscopy, surgical; urethral suspension for stress incontinence

51992 Laparoscopy, surgical; sling operation for stress incontinence (eg, fascia or synthetic)

57291 Construction of artificial vagina; without graft

57305 Closure of rectovaginal fistula

57423 Paravaginal defect repair (including repair of cystocele, if performed), laparoscopic approach

57425 Laparoscopy, surgical, [sacro]colpopexy (suspension of vaginal apex)

57426 Revision (including removal) of prosthetic vaginal graft, laparoscopic approach

58541 Laparoscopy, surgical, supracervical hysterectomy (LSH), for uterus 250 g or less

58542 58543

Laparoscopy, surgical, supracervical hysterectomy (LSH), for uterus 250 g or less; with

removal of tube(s) and/or ovary(s) Laparoscopy, surgical, supracervical hysterectomy (LSH), for uterus greater than 250 g

58544

Laparoscopy, surgical, supracervical hysterectomy (LSH), for uterus greater than 250 g; with removal of tube(s) and/or ovary(s)

58545

Laparoscopy, surgical, myomectomy, excision; 1 to 4 intramural myomas with total weight of 250 g or less and/or removal of surface myomas

58546

Laparoscopy, surgical, myomectomy, excision; 5 or more intramural myomas and/or intramural myomas with total weight greater than 250 g

Laparoscopy, surgical, with radical hysterectomy, with bilateral total pelvic lymphadenectomy

58548 and para-aortic lymph node sampling (biopsy), with removal of tube(s) and ovary(s), if

performed

58550 Laparoscopy, surgical, with vaginal hysterectomy (LAVH), for uterus 250 g or less

58552

Laparoscopy, surgical, with vaginal hysterectomy (LAVH), for uterus 250 g or less; with removal of tube(s) and/or ovary(s)

58553 58554 58570 58571 58572 58573

58661

Laparoscopy, surgical, with vaginal hysterectomy (LAVH), for uterus greater than 250 g

Laparoscopy, surgical, with vaginal hysterectomy (LAVH), for uterus greater than 250 g; with removal of tube(s) and/or ovary(s) Laparoscopy, surgical, with total hysterectomy (TLH), for uterus 250 g or less

Laparoscopy, surgical, with total hysterectomy (TLH), for uterus 250 g or less; with removal of tube(s) and/or ovary(s) Laparoscopy, surgical, with total hysterectomy (TLH), for uterus greater than 250 g

Laparoscopy, surgical, with total hysterectomy (TLH), for uterus greater than 250 g; with removal of tube(s) and/or ovary(s) Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy)

COEMIS-G Qualifying Procedures with CPT Codes Rev 05/2016

58662 58672 58673 58700 58720 58750 58925

58943

58950

58952

58957

58958

58960

Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface - qualify for ASRM Stage II, III, or IV Laparoscopy, surgical; with fimbrioplasty Laparoscopy, surgical; with salpingostomy (salpingoneostomy) Salpingectomy, complete or partial, unilateral or bilateral (separate procedure) Salpingo-oophorectomy, complete or partial, unilateral or bilateral (separate procedure) Tubotubal anastomosis Ovarian cystectomy, unilateral or bilateral

Oophorectomy, partial or total, unilateral or bilateral; for ovarian, tubal or primary peritoneal malignancy, with para-aortic and pelvic lymph node biopsies, peritoneal washings, peritoneal biopsies, diaphragmatic assessments, with or without salpingectomy(s), with or without omentectomy Resection (initial) of ovarian, tubal or primary peritoneal malignancy with bilateral salpingooophorectomy and omentectomy Resection (initial) of ovarian, tubal or primary peritoneal malignancy with bilateral salpingooophorectomy and omentectomy; with radical dissection for debulking (ie, radical excision or destruction, intra-abdominal or retroperitoneal tumors) Resection (tumor debulking) of recurrent ovarian, tubal, primary peritoneal, uterine malignancy (intra-abdominal, retroperitoneal tumors), with omentectomy, if performed Resection (tumor debulking) of recurrent ovarian, tubal, primary peritoneal, uterine malignancy (intra-abdominal, retroperitoneal tumors), with omentectomy; with pelvic lymphadenectomy and limited para-aortic lymphadenectomy Staging or restaging of ovarian, tubal, or primary peritoneal malignancy (second look), with or without omentectomy, peritoneal washing, biopsy of abdominal and pelvic peritoneum, diaphragmatic assessment with pelvic and limited para-aortic lymphadenectomy

? Current Procedural Terminology (CPT?) codes and descriptions are copyright 2013 American Medical Association. All rights reserved

COEMIS-G Qualifying Procedures with CPT Codes Rev 05/2016

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