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Posted By dawn b on 01-23-2019, 13:29:56 in Ob-Gyn
I have several physicians who do hysterectomies and I am trying to figure out a clear difference between these two codes. Can anyone clarify this?
Thanks
Comments (2)
Posted By dawn b on 01-24-2019, 06:55:36
Perfect! Thank you again Melanie
Posted By Melanie Witt on 01-23-2019, 17:55:17
We covered this in a 2010 Issue of the Ob-Gyn Coding Alert (Volume 38, Number 8):

For a total laparoscopic hysterectomy (TLH), the ob-gyn can remove the uterus via the scope or vaginally in one piece. What makes the difference is how the ob-gyn severs the connections and how the ob-gyn sews the vaginal cuff.

Difference 1: In the laparoscopic with vaginal hysterectomy (LAVH) cases, the ob-gyn severs only the upper connections via the scope. In the TLH case, the ob-gyn severs both upper and lower connections through the scope.

Difference 2: In an LAVH, the ob-gyn enters the vaginal wall from below to remove the uterus. In a TLH, the ob-gyn circumscribes the cervix from above to release the organ and pull it through the vaginal canal. Note that he can also remove the uterus using the scope after morcellating the uterus, but either approach can still represent the TLH.

Difference 3: In an LAVH, the ob-gyn sews the vaginal cuff closed from below, in a TLH, it is sewn closed via the scope.
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