CPT® Code 58546

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

The procedure described by CPT® Code 58546 involves a laparoscopic surgical technique known as myomectomy, specifically targeting the excision of five or more intramural myomas or intramural myomas that collectively weigh more than 250 grams. Myomas, commonly referred to as uterine fibroids, are benign tumors that develop from the muscle tissue of the uterus, known as the myometrium. These fibroids can manifest in various forms, including submucous, intramural, subserous, or pedunculated types. Submucous fibroids extend into the uterine cavity and are typically addressed through hysteroscopy, while intramural fibroids are embedded within the uterine muscle itself. Subserous fibroids are located on the outer surface of the uterus and may be attached by a thin stalk, known as pedunculation. During the laparoscopic myomectomy, the surgeon makes a small incision below the umbilicus to insert a trocar, which allows for the introduction of a laparoscope—a specialized instrument that provides visual access to the uterus. The surgeon inspects the uterus to locate the fibroids and then creates two or three additional incisions in the lower abdomen to facilitate the insertion of surgical instruments. For surface fibroids, an incision is made directly over the fibroid to detach it from the uterine wall. In the case of intramural fibroids, the surgeon incises the uterus down to the fibroid level, carefully peeling the tumor away from the myometrium. Depending on the fibroid's size, it may be removed intact or morcellated into smaller pieces for extraction. Throughout the procedure, any bleeding is managed using electrocautery, and the uterus is subsequently repaired in layers with sutures. This procedure is indicated for patients with multiple or significantly large fibroids, providing a minimally invasive option for symptom relief and preservation of uterine function.