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vNotes Hysterectomy – December 2021 Coding Tip

Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy is a innovative approach to perform a vaginal hysterectomy. This approach allows surgeons to perform a vaginal hysterectomy under endoscopic vision. “A laparoscopic device is inserted via incisions made in the vagina. The device inflates the abdomen with carbon dioxide, similar to a laparoscopic procedure, however there are no abdominal incisions. A high-definition camera and surgical instruments are inserted through the device to perform the hysterectomy.”1

In Coding Clinic for HCPCS, Third Quarter 2021 a question was submitted that asked “how is a vNOTES hysterectomy that combines vaginal and laparoscopic techniques without abdominal skin incisions coded ?”. 2 In the scenario given the patient had a vNOTES hysterectomy with bilateral salpingectomy.

Coding clinic replied that a code from CPT code range 58260-58294 was to be selected as it captured the vaginal hysterectomy based on what was performed during the operation and the weight of the uterus and that although a laparoscopic device was utilized, the hysterectomy was still performed vaginally.

1,2  Coding Clinic for HCPCS, Third Quarter 2021; Page 10