Summary & Overview
CPT 58540: Abdominal Hysteroplasty for Uterine Anomaly Repair
CPT code 58540 represents an abdominal hysteroplasty: operative reconstruction of a congenitally anomalous uterus (for example, conversion of a bicornuate uterus to a single cavity). This gynecologic procedure is clinically significant for fertility preservation and symptom relief and may require variable operative time and resources depending on the complexity of uterine reconstruction. Nationally, correct coding and site-of-service determination affect hospital and ambulatory surgical center workflows, perioperative authorization, and claims adjudication.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context and typical sites of service, a summary of common billing modifiers used with the procedure, payer coverage considerations and typical authorization concerns, and relevant coding relationships. The publication outlines common operational benchmarks and policy considerations that influence billing and reimbursement for complex gynecologic reconstructive surgery. Where specific payer policies or rates are not provided in the input, the text notes that such data is not available.
This summary serves clinicians, coding professionals, and revenue cycle stakeholders seeking a focused national overview of coding, clinical context, and payer considerations for CPT code 58540.
Billing Code Overview
CPT code 58540 describes an abdominal hysteroplasty performed to correct a uterine anomaly (for example, converting a bicornuate uterus with two horns into a single uterine cavity). The procedure involves surgical reconstruction of the uterus and can range from limited repair to an extensive plastic repair depending on the anomaly and intraoperative findings.
Service type: Operative gynecologic procedure — reconstructive uterine surgery
Typical site of service: Inpatient or outpatient hospital surgical setting or ambulatory surgical center, performed via an abdominal approach.
Clinical & Coding Specifications
Clinical Context
A 32-year-old woman with a history of recurrent first-trimester pregnancy loss is evaluated for a uterine anomaly. Imaging with pelvic ultrasound and MRI demonstrates a bicornuate uterus with two distinct uterine horns and a partial fundal cleft. After multidisciplinary consultation, the patient is scheduled for an abdominal hysteroplasty to unify the uterine cavity and improve reproductive outcomes. The procedure is performed in an operating room under general anesthesia via a low transverse laparotomy or Pfannenstiel incision. Intraoperative steps include inspection of the uterus, incision into the fundal cleft, mobilization of myometrial tissue, approximation of myometrial edges to create a single cavity, and multilayer closure. Estimated blood loss, intraoperative findings, and any concurrent procedures (for example, diagnostic hysteroscopy to confirm cavity anatomy or serosal reinforcement) are documented. Postoperative care includes routine recovery monitoring, pain control, thromboprophylaxis as indicated, and discharge planning with obstetric follow-up for future pregnancies.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the hysteroplasty requires substantially greater effort, time, or technical difficulty than usual and documentation supports the increased work. |