CPT 59525: Cesarean Delivery with Subtotal (Partial) Hysterectomy
CPT code 59525 denotes a cesarean delivery performed with a concurrent subtotal (partial) hysterectomy, in which the uterus is removed while the cervix is left intact. This code captures a high-acuity obstetric surgical service commonly required for severe intrapartum or postpartum complications that cannot be managed with uterine-sparing techniques. Nationally, accurate use of this code affects hospital surgical case mix, maternal morbidity reporting, and reimbursement for complex obstetric care.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for 59525, standard sites of service, and typical service classification. The publication also provides benchmarks for coding and billing practices, discussion of payer coverage patterns, and relevant policy considerations impacting claims processing and reimbursement for combined cesarean and hysterectomy procedures.
This summary highlights what clinicians and coding professionals need to know about proper application of CPT code 59525, how it is distinguished from isolated cesarean or hysterectomy codes, and the implications for hospital reporting and payer adjudication. Data not available in the input will be noted where applicable in detailed sections.
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Billing Code Overview
CPT code 59525 describes a cesarean delivery with concurrent subtotal (partial) hysterectomy, where the provider performs a cesarean birth and surgically removes the uterus during the same operative session, leaving the cervix in place. This procedure is typically performed when maternal indications arise during or immediately after delivery that require removal of the uterus while preserving the cervix.
Service Type: Surgical obstetric procedure
Typical Site of Service: Hospital operating room or other inpatient surgical setting
Clinical & Coding Specifications
Clinical Context
A 32-year-old G2P1 patient presents in active labor with a nonreassuring fetal heart tracing and a history of previous cesarean delivery. The obstetric team proceeds with an urgent repeat cesarean delivery in the operating room under regional anesthesia. Intraoperatively, the surgeon identifies extensive uterine atony and uncontrolled hemorrhage refractory to uterotonics and conservative measures. To control bleeding and stabilize the patient, the provider performs a subtotal (partial) hysterectomy at the same operative session as the cesarean delivery, removing the uterine corpus while leaving the cervix in place. The immediate perioperative workflow includes maternal stabilization, anesthesia management, surgical time-out, cesarean delivery of the neonate, uterine repair attempts, conversion to hysterectomy, estimated blood loss assessment, transfusion as needed, and postoperative monitoring in the recovery unit with obstetric and critical care follow-up.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the subtotal hysterectomy required significantly greater effort, time, or risk than usual (e.g., dense adhesions, extensive hemorrhage) and documentation supports increased work. |
23 | Unusual anesthesia | Use if general anesthesia was required for emergency circumstances when neuraxial anesthesia would normally be used. |
52 | Reduced services | Use when the subtotal hysterectomy was partially reduced or not completed as typically described. |
53 | Discontinued procedure | Use when the hysterectomy was started but halted due to patient instability or other intraoperative complications. |
54 | Surgical care only | Use when billing only for the surgeon's operative component separate from global maternity care. |
55 | Postoperative management only | Use when the surgeon bills only for postoperative management separate from the operative service. |
62 | Two surgeons | Use when two surgeons of different specialties perform distinct portions of the subtotal hysterectomy during the same operative session. |
63 | Procedural service by an assistant surgeon | Use when a physician assistant or other qualified practitioner performed portions of the procedure under appropriate supervision rules. |
78 | Return to OR for related procedure by same physician | Use when the patient returns to the operating room for a related procedure following the initial subtotal hysterectomy in the postoperative period. |
79 | Unrelated procedure or service by the same physician during the postoperative period | Use when an unrelated operative procedure occurs during the global postoperative period. |
59 | Distinct procedural service | Use to indicate a distinct service separate from other procedures performed during the same session when appropriate and supported by documentation. |
62 | Two surgeons | (Listed once in table as above) |
11 | Office or other outpatient service as usual | Use when billing reflects usual, uncomplicated care (rarely applied to cesarean-hysterectomy operative code). |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207V00000X | Obstetrics & Gynecology | Primary specialty performing cesarean delivery and concomitant hysterectomy. |
| 207VP0126X | Maternal-Fetal Medicine | Manages high-risk obstetric patients and complex intraoperative decisions. |
| 363A00000X | Anesthesiology | Provides regional or general anesthesia and critical perioperative management. |
| 207L00000X | Gynecologic Oncology | May be involved when there are complex surgical adhesions or malignancy considerations. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
O72.0 | Intrapartum hemorrhage | Indicates significant bleeding during labor that may necessitate hysterectomy at cesarean to control hemorrhage. |
O72.1 | Postpartum hemorrhage, retained placenta | Retained placental tissue leading to hemorrhage and possible need for hysterectomy when conservative measures fail. |
O34.21 | Maternal care for scar from previous cesarean delivery, delivered, with mention of postpartum complication | Prior cesarean increases risk of placenta accreta spectrum and hemorrhage prompting cesarean hysterectomy. |
O43.2 | Placenta accreta spectrum (placenta accreta, increta, percreta) | Abnormal placental adherence leading to life-threatening hemorrhage often requiring hysterectomy at delivery. |
O76 | Abnormality in fetal heart rate and rhythm complicating labor and delivery | May precipitate urgent cesarean delivery during which hysterectomy becomes necessary for hemorrhage control. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
59510 | Routine obstetric care including antepartum care, cesarean delivery, and postpartum care | Represents the global code for a cesarean delivery; 59525 is performed during the same operative session when hysterectomy is added. |
59514 | Cesarean delivery only (global) for repeat cesarean without antepartum care by the delivering surgeon | Alternative cesarean code sometimes used depending on global billing arrangements when hysterectomy is added. |
58999 | Unlisted procedure, uterus | May be used rarely for unusual uterine procedures not described by standard codes; not typical when 59525 applies. |
58611 | Laparoscopy, surgical, with removal of adnexal structures (adnexectomy) | May be performed if concurrent adnexal removal is necessary during hysterectomy. |
43774 | Laparoscopy, surgical, with hysterectomy, subtotal or total (when approach differs) | Used when a laparoscopic approach is employed for subtotal hysterectomy; relates by approach variation. |