I will just type to you the part of the op-note that I believe goes over it. Incision was made along the cervicovaginal junction. The anterior and posterior cul-de-sac were entered without difficulty after some bites were taken incorporating the uterosacral ligaments and cardinal ligaments. There were adhesions anteriorly,dense adhesions where the c-section scars were,but dissection below these areas were sufficient.The uterine vessels were bilaterally clamped,cut, and doubly ligated with 0 Vicryl suture, incorporated in the anterior and posterior leaves of the broad ligaments. Two more bites were taken. Uterus was fairly bulky,did not flip very well. The cervix was amputated to make it allow easier approach to the left ovarian, uterine ligament,round ligament and tube,which was doubly clamped, cut, and doubly ligated with Vicryl suture in heaney fashion. In this fashion the right was done similarly.
That is what I have in op-note and basically the patient has/had a known leiomyomatous uterus, it was slightly enlarged and irregular shaped. So the way I understand it is like doing a myomectomy along with vaginal hysterectomy but those codes together do not pass CCI edits. The problem I have with that is that it is more work for him. Of course he could change it to abdominal hysterectomy, but thinks of patient. So I am thinking the only thing would either be unlisted code or modifier 22. It is the point that he is doing more than just a vaginal hysterectomy. Sorry this is so lengthy. Appreciate your feed back