Summary & Overview
CPT 58280: Vaginal Hysterectomy with Enterocele Repair
CPT code 58280 represents a vaginal hysterectomy that removes the uterus and cervix through a vaginal approach and includes partial or complete excision of the vagina with repair of small bowel prolapse (enterocele). This procedure is a key gynecologic pelvic reconstructive surgery used to treat uterine pathology and concomitant pelvic organ prolapse complications. Nationally, it is relevant to hospitals, ambulatory surgical centers, and payers due to its surgical complexity, potential for concurrent procedures, and implications for perioperative care and postacute needs.
Key payers addressed in this publication include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for the procedure, typical sites of service, common modifiers used in billing, and the aspects of claims adjudication and coverage that commonly affect payments for vaginal hysterectomy with enterocele repair. The summary highlights benchmarks and coding considerations, outlines where additional documentation commonly affects claim outcomes, and identifies policy elements that influence coverage decisions and prior-authorization practices. Data not available in the input is clearly noted where applicable.
Billing Code Overview
CPT code 58280 describes a vaginal hysterectomy with partial or complete excision of the vagina and repair of small bowel prolapse into the vaginal canal. The procedure involves surgical removal of the uterus and cervix via a vaginal approach, with concurrent vaginal tissue excision and repair of enterocele (small bowel prolapse) when present.
Service type: Surgical—gynecologic pelvic reconstructive surgery
Typical site of service: Hospital operating room or ambulatory surgical center, vaginal surgical suite
Clinical & Coding Specifications
Clinical Context
A 62-year-old woman presents with symptomatic pelvic organ prolapse and recurrent vaginal cuff enterocele with small bowel prolapse causing obstructive symptoms and pelvic pressure. Conservative measures including pessary use and pelvic floor therapy failed. The patient has completed childbearing and elects definitive surgical management. Preoperative evaluation includes history and physical, pelvic examination confirming vaginal apex prolapse with enterocele, labs, anesthesia assessment, and informed consent. The patient is taken to the operating room under general or regional anesthesia. The surgeon performs a vaginal hysterectomy with removal of the uterus and cervix via a vaginal approach, performs partial or complete excision of redundant vaginal epithelium as indicated, reduces the small bowel prolapse, repairs the enterocele defect (vaginal apex and posterior compartment repair), and achieves hemostasis. Intraoperative steps include vaginal cuff closure and pelvic floor repair techniques; concurrent procedures such as bilateral salpingo-oophorectomy, anterior/posterior colporrhaphy, or sling procedures may be documented separately. Typical recovery involves post-anesthesia monitoring in PACU, inpatient or same-day discharge depending on comorbidities, and postoperative follow-up for wound healing and pelvic support assessment.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services |