CPT® Code 58291

The CPT® Code 58291 refers to a surgical procedure known as a vaginal hysterectomy, specifically indicated for the removal of an enlarged uterus weighing greater than 250 grams, along with the removal of the fallopian tubes and/or ovaries. This procedure is typically performed when the uterus is significantly enlarged, which may necessitate the use of morcellation techniques to facilitate its removal in multiple pieces. Morcellation can involve various methods such as hemisection, where the uterus is divided into two halves; intramyometrial coring, which involves removing a core of tissue from the interior of the uterus to reduce its size; or wedge resection, which entails cutting the uterus into smaller segments. The procedure begins with the placement of tenacula on the cervix to provide traction, followed by an incision of the vaginal mucosa around the cervix. The bladder is then carefully separated from the uterus using both blunt and sharp dissection techniques. This meticulous approach allows for the elevation of the bladder to expose the peritoneal vesicouterine fold, which is subsequently incised. The surgical team then exposes the cul-de-sac and incises the peritoneum, ligating the uterine vessels to control bleeding. The morcellation technique is employed to remove the uterus while severing its attachments. As the uterus is exteriorized, the broad ligament becomes visible, and the uterosacral ligaments are clamped and divided. The cardinal ligaments are clamped at the lower uterine segment, incised, and ligated with sutures. The procedure continues with the clamping and division of the lower portion of the broad ligament at its attachment to the lower uterine segment. The tubo-ovarian round ligaments are then exposed, clamped, and incised near the uterine fundus on both sides, followed by the transection of the fallopian tubes. If the tubes and ovaries are to be removed, the round ligaments are cut and tied bilaterally, and the infundibulopelvic ligaments are cut to facilitate the removal of the tubes and ovaries along with the morcellized uterus. The anterior vaginal wall is elevated, and the broad ligament is inspected for bleeding, which is controlled before closing the peritoneum. The vaginal cuff is intentionally left open to allow for drainage of the pelvis. This code is specifically used when both the uterus and the adnexa (tubes and ovaries) are removed, distinguishing it from other related codes that describe variations of the procedure.