CPT® Code 58275

The CPT® Code 58275 refers to a surgical procedure known as a vaginal hysterectomy, which is performed in conjunction with either a total or partial vaginectomy. This procedure involves the removal of the uterus through the vaginal canal, and it may also include the excision of part or all of the vaginal wall. The process begins with the placement of tenacula, which are surgical instruments used to grasp the cervix, allowing for better access to the surgical site. The vaginal mucosa, which is the lining of the vagina, is then incised around the cervix to facilitate the dissection and removal of surrounding structures. During the procedure, traction is applied to the tenacula to stabilize the cervix, and the bladder is carefully separated from the uterus using both blunt and sharp dissection techniques. This step is crucial to prevent injury to the bladder during the surgery. The bladder is elevated to provide a clear view of the peritoneal vesicouterine fold, which is subsequently incised to access the cul-de-sac, where the peritoneum is also incised. The broad ligament, which supports the uterus, is exposed, and the uterosacral ligaments are clamped and divided to facilitate the removal of the uterus. The cardinal ligaments are clamped at the lower uterine segment, incised, and ligated with sutures to ensure hemostasis. The lower portion of the broad ligament is similarly clamped and divided. Once the posterior uterine wall is grasped, the uterus is delivered into the vagina. The procedure continues with the exposure and clamping of the tubo-ovarian round ligaments, which are then incised close to the uterine fundus on both sides. The fallopian tubes are transected, and the tubo-ovarian ligaments are doubly ligated before the uterus is completely removed. After the uterus is excised, the fallopian tubes are returned to the abdominal cavity, and the surgical site is inspected for any bleeding, which is controlled as necessary. The peritoneum is then closed to complete the internal portion of the procedure. Following the hysterectomy, the vaginectomy is performed, which involves the removal of part or all of the vaginal wall. This is achieved through two longitudinal full-thickness incisions made along the anterior and posterior aspects of the vaginal wall, extending from the top of the vaginal vault to a specified point depending on whether a partial or total vaginectomy is being performed. The incisions allow for the excision of the vaginal wall, and if necessary, vaginal reconstruction with skin grafts may be reported separately. It is important to note that this code (58275) is specifically used when the vaginal hysterectomy and vaginectomy are performed without any enterocele repair, which is a separate procedure that may require a different coding (58280) if performed concurrently.