# 58661 vs 58670



## Riley

My docs have been doing salpingectomies for sterilization's due to the ACOG's new guidelines. Are most coders doing the 58661 instead of the 58670 for these surgeries? icd10 Z30.2 Are most people finding insurances are paying on the 58661 with the icd10 Dx? thanks for your response.


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## Cmama12

Do you have a link to this guideline?  I am not seeing anything from ACOG about this particular topic.

 This is a hot topic right now at my place of employment.    I have found that some Medicaid providers are listing the 58661 as a sterilization code but have not seen any commercial that do thus far.

We had been changing the 58661 to 58670 and now have been told to put through FOR NOW as 58661 if they remove the tubes in entirety.


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## catharine

I only use the 58661 if in the operative report they indicate that they removed the section. I have not heard about this from ACOG.


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## kellyg

I have contacted ACOG directly about this issue. The response indicated that ACOG has published Committee Opinion 260 "Salpingectomy for Ovarian Cancer Prevention" dated January 2015. There is not a CPT code for reporting prophylactic salpingectomies.  You must code what was done.  If the provider performed a laparoscopic salpingectomy for sterilization purposes, you must code 58661 not 58670. We are finding insurance plans will cover it but they may not cover it under the contraceptive benefit which often covers at 100% or other plans are requiring prior authorization. Our Medicaid will cover it with the exception of the Medicaid plans which cover Family Planning Only. They will not.


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## valleyobgynut

My doctors have been doing the same thing. I bill 58661 with the Z30.2 and insurance companies have been paying just fine.


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## KDOBBS83

Does anyone have a link to ACOG to support the 58661 vs 58670? I am currently having the same concern with my providers.


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## Anastasia

58661 is performed for a disease process, 58671 for sterilization. See Optum's Coding Companion for Obstetrics & Gynecology for detailed explanation.


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## bharathiT

*58670 vs 58661?*

PREOPERATIVE DIAGNOSIS: Desires permanent sterilization.

POSTOPERATIVE DIAGNOSIS: Desires permanent sterilization.

PROCEDURE: Laparoscopic tubal salpingectomy, Bipolar cautery method

ANESTHESIA: General.

COMPLICATIONS: None.

INDICATIONS FOR SURGERY: A  40  year-old female,   multipara who desires permanent sterilization as well as risk reduction for ovarian cancer. The risks of alternatives, bleeding, infection, damage to other organs, and subsequent ectopic pregnancy was explained. Informed consent was obtained.

OPERATIVE FINDINGS: Normal appearing uterus and adnexa bilaterally.

DESCRIPTION OF PROCEDURE: After administration of general anesthesia, the patient was placed in the dorsal lithotomy position, and prepped and draped in the usual sterile fashion. The speculum was placed in the vagina, the cervix was grasped with the tenaculum, and a uterine manipulator inserted. This area was then draped off the remainder of the operative field.

A 5-mm incision was made umbilically after injecting local anesthesia. A 5mm trochar was introduced and the abdomen was insufflated with CO2 gas. Position was confirmed using a laparoscope. Tow other 8 and 5mm ports were placed under direct visualization, after local was injected.  The pelvic cavity was examined with the findings as noted above. The right fallopian tube was grasped with the Kleppenger and followed to the fimbriated end. The Bipolar cautery was used to cauterize the surrounding vessels and the fallopian tube was dissected from its surrounding tissue.  The same procedure was repeated on the contralateral side. The accessory ports were removed. The abdomen was deflated. The laparoscope and sheaths were removed. The skin edges were approximated with 4-0 vicryl suture in subcuticular fashion. The instruments were removed from the vagina.
All counts were correct at the end of the procedure. 
The patient was stable when she was taken to the recovery room as she tolerated the procedure well.


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## tracylc10

bharathiT said:


> PREOPERATIVE DIAGNOSIS: Desires permanent sterilization.
> 
> POSTOPERATIVE DIAGNOSIS: Desires permanent sterilization.
> 
> PROCEDURE: Laparoscopic tubal salpingectomy, Bipolar cautery method
> 
> ANESTHESIA: General.
> 
> COMPLICATIONS: None.
> 
> INDICATIONS FOR SURGERY: A  40  year-old female,   multipara who desires permanent sterilization as well as risk reduction for ovarian cancer. The risks of alternatives, bleeding, infection, damage to other organs, and subsequent ectopic pregnancy was explained. Informed consent was obtained.
> 
> OPERATIVE FINDINGS: Normal appearing uterus and adnexa bilaterally.
> 
> DESCRIPTION OF PROCEDURE: After administration of general anesthesia, the patient was placed in the dorsal lithotomy position, and prepped and draped in the usual sterile fashion. The speculum was placed in the vagina, the cervix was grasped with the tenaculum, and a uterine manipulator inserted. This area was then draped off the remainder of the operative field.
> 
> A 5-mm incision was made umbilically after injecting local anesthesia. A 5mm trochar was introduced and the abdomen was insufflated with CO2 gas. Position was confirmed using a laparoscope. Tow other 8 and 5mm ports were placed under direct visualization, after local was injected.  The pelvic cavity was examined with the findings as noted above. The right fallopian tube was grasped with the Kleppenger and followed to the fimbriated end. The Bipolar cautery was used to cauterize the surrounding vessels and the fallopian tube was dissected from its surrounding tissue.  The same procedure was repeated on the contralateral side. The accessory ports were removed. The abdomen was deflated. The laparoscope and sheaths were removed. The skin edges were approximated with 4-0 vicryl suture in subcuticular fashion. The instruments were removed from the vagina.
> All counts were correct at the end of the procedure.
> The patient was stable when she was taken to the recovery room as she tolerated the procedure well.




This came up in our office recently as well and we are going with 58661 with dx code Z30.2.


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## bharathiT

*why not 58670?*

thanks for response!

My doubt about patient come for sterilization technique with multipara ,why donot use 58670 ?


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## Cmama12

This was a hot topic with us a few years ago when providers started fully removing the tubes. We have been billing 58661 with Z30.2 without issue.  

https://www.acog.org/Clinical-Guida...r-Ovarian-Cancer-Prevention?IsMobileSet=false


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## tracylc10

bharathiT said:


> thanks for response!
> 
> My doubt about patient come for sterilization technique with multipara ,why donot use 58670 ?




I believe that this is because they are taking most, if not all of the tube.


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## csperoni

UPDATE!!
Even though this thread is older, I know many people research before posting a question that has been asked and answered previously.  I was recently corrected that laparoscopic removal of fallopian tubes, even for sterilization is now recommended by ACOG as 58661 NOT 58670 as previously advised.  
https://acogcoding.freshdesk.com/su...gectomy-changes-to-cpt-58661-recommendations-  states:  

Coding Alert! Laparoscopy: Salpingectomy (Changes to CPT 58661 Recommendations)​ *                    Lisa Satterfield                  * 
Modified on: Tue, 27 Jul, 2021 at 12:53 PM

Following a policy analysis of payer coverage and a discussion with the American Medical Association’s CPT Assistant Editorial Board and the CPT Panel’s Executive Committee, ACOG is revising recommendations for the use of CPT 58661: _Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy)_.

ACOG has determined that the evidence validates CPT 58661 for the removal of the fallopian tubes for sterilization laparoscopically, and not the previous recommendation, CPT 58670.

Therefore, ACOG is recommending that CPT 58661 is the appropriate code for the removal of the fallopian tubes for sterilization.

As always, please confirm with individual payers for prior authorization and billing.


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