# ectopic pregnancy



## hgonzales

my doctor removed an ectopic pregnancy by laprocsopy with salpinostomy.  I've coded using salpinectomy but not salpinostomy which I know is creating an opening in the tube and removing the ectopic pregnancy that way.  We deal with alot of Medicaid and when I look up in the OB CPT code book salpineostomy- the dx for ectopic pregnancy is not there.  Trying to match up dx with CPT code so Medicaid pays.  Please help since I need to code by end of this week.

Thanks,
Hilda


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## eadun2000

hgonzales said:


> my doctor removed an ectopic pregnancy by laprocsopy with salpinostomy.  I've coded using salpinectomy but not salpinostomy which I know is creating an opening in the tube and removing the ectopic pregnancy that way.  We deal with alot of Medicaid and when I look up in the OB CPT code book salpineostomy- the dx for ectopic pregnancy is not there.  Trying to match up dx with CPT code so Medicaid pays.  Please help since I need to code by end of this week.
> 
> Thanks,
> Hilda



Per my encoder it is 59150 with 66.02 for icd-9 procedure code. 

Per Ingenix Coder's Desk Reference "The physician treats an ectopic pregnancy by laparoscopy without salpingectomy and/or oophorectomy. The physician inserts an instrument through the vagina to grasp the cervix while passing another instrument through the cervix and into the uterus to manipulate the uterus. Next, the physician makes a 1 cm incision in the umbilicus through which the abdomen is inflated and a fiberoptic laparoscope is inserted. A second incision is made on the left or right side of the abdomen. After locating the site of the gestation, another small incision is made above the site. Instruments are passed into the abdomen through the incisions. The physician removes the ectopic pregnancy by making an incision in the tube or ovary or by segmental excision. The abdominal incisions are closed with sutures."

Per CPT Assistant November 1999 "Maternity Care and Delivery

Other Procedures

59898            Unlisted laparoscopy procedure, maternity care and delivery

The two laparoscopic ectopic pregnancy codes 59150, 59151 will remain in the maternity care and delivery section. A new code has been added to describe “unlisted” maternity care and delivery laparoscopic procedures. Code 59899 will continue to be reported for “non-laparoscopic,” unlisted maternity care and delivery procedures."

Hope this helps


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## hgonzales

Thank you for your quick response but now we don't use the icd- procedural codes.  I doing hospital billing for the doctor and our dx are the cm diagnostic ones.  Can I bill 59150 and 58673 to show the salpinostomy part of it with a modifier for the 2nd procedure? 
thank you,
HIlda


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## eadun2000

hgonzales said:


> Thank you for your quick response but now we don't use the icd- procedural codes.  I doing hospital billing for the doctor and our dx are the cm diagnostic ones.  Can I bill 59150 and 58673 to show the salpinostomy part of it with a modifier for the 2nd procedure?
> thank you,
> HIlda



No.  You only code the 59150.  It includes the laparoscopic salpinostomy.


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## preserene

Eadun 2000 is correct.

Salpingectomy refers to the surgical removal/excision ofFallopian tube. Salpingectomy is different from a salpingostomy and salpingotomy.

Salpingostomy and salpingotomy: These two terms are often used interchangeably and refer to creating an opening into the tube (e.g. to remove an ectopic pregnancy), but the tube itself is not removed. Technically, the creation of a new tubal opening (os) by surgery would be a salpingostomy, while the incision into the tube to remove an ectopic is a salpingotomy.

For most tubal ectopic pregnancies (EP), surgery is the treatment of first choice. Whether surgical treatment should be performed conservatively (salpingostomy) or radically (salpingectomy) in women wishing to preserve their reproductive capacity, is subject to debate. Salpingostomy preserves the tube(  salpingostomy carries a 5-8% risk of persistent ectopic pregnancy, contributing to increased morbidity and cost. By performing salpingectomy when the contralateral tube is normal, half the additional cost and morbidity could be avoided without jeopardizing subsequent fertility. It is a heacth care and cost issue for the heathcare budget and we are not going into the debate anyway now.)

*Salpingostomy has gradually replaced salpingectomy as the surgical procedure of choice for unruptured tubal pregnancy in women who wish to preserve fertility*

*As for coding issue:*
LAP. ECTOPiC pregnancy has 2 CPT codes only: 59151 and  59150. 59150 deals with the surgical treatment without salpngectomy and /or oopherectomy The salpingostomy procedure is  a component of this code. We do not have to go for a separate code like 58673 though the word salpingostomy tempts us to do so. But this code is for other salpingostomy procedures which are not connected with ectopic management.


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