CPT® Code 58563

A surgical hysteroscopy with endometrial ablation is a minimally invasive procedure that involves the use of a hysteroscope, a thin, lighted tube, to visualize the inside of the uterus. This procedure is specifically designed to treat conditions associated with excessive or abnormal uterine bleeding, known as menorrhagia. During the procedure, various techniques may be employed for the ablation of the endometrium, which is the inner lining of the uterus. These techniques include endometrial resection, electrosurgical ablation, and thermoablation, each of which effectively removes or destroys the endometrial tissue to alleviate bleeding. Prior to the insertion of the hysteroscope, a bimanual pelvic examination is conducted to assess the uterus and surrounding structures. The cervix is then prepared for the procedure by applying a single-tooth tenaculum to the anterior cervical lip, which helps stabilize the cervix. A sound is passed through the cervix to measure the depth and angle of the uterus, ensuring proper placement of the hysteroscope. The cervix is numbed and dilated using metal dilators, allowing for the safe insertion of the hysteroscope into the endocervical canal and advancement into the uterine cavity. To facilitate visualization and access, the uterine cavity is expanded using either saline or carbon dioxide. Once the hysteroscope is in place, the uterine cavity is thoroughly examined. The ablation process begins with the application of an electrosurgical roller-ball, which delivers electric current to the endometrial tissue, starting at the uterine horns and progressing through the cornua, tubal angles, and the walls of the uterus. Alternatively, thermoablation may be performed using a balloon catheter filled with heated fluid, which is applied against the endometrial lining to achieve the desired effect. In some cases, a resectoscope may be utilized, which features a built-in wire that conducts electrical current to resect the endometrial tissue in strips, which are then removed using polyp forceps. After the procedure, all instruments are carefully removed, and any bleeding from the cervical lip is managed through the application of pressure.