# bilateral tubal ligation via salpingectomy



## ltingle1 (May 27, 2020)

Hello,

I am having an issue with our MDs and coding for sterilization.  My understanding is that for sterilization, if the MD is doing a BTL and removes a portion of the tube, it is still considered a BTL and not a salpingectomy, so I would code 58670 and not 58661.  (not done at time of c/s)
However, some of our MDs are arguing that if they are removing a portion of the tube that it is then considered a partial salpingectomy and should therefore be coded as 58661. 
What is the correct code for a tubal ligation via partial salpingectomy (they are removing 2-4 cm of tube)

Thanks,
Lauren


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## SharonCollachi (May 27, 2020)

Similar recent discussion here.

More info here.

Some articles say that tubal without removing some of the tube is basically, not the best way to do the procedure.

One article I was reading said that coding tube removal is for disease process, not for sterilization.  Another thing to consider:  tubal made be covered at 100% for contraception, and tube removal may be subject to regular deductibles and copays (which can be massive these days).  If I went in for a tubal and they billed something that made it not strictly contraception, I would be on the phone in a big, big way.  BIG.


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## csperoni (May 27, 2020)

You do not specify in your question, but since both codes are laparoscopic, so I will assume the procedure was done laparoscopically.  
If they are only removing a small portion of tube for the purpose of sterilization, 58670 is the correct code.  
Here is the full Supercoder description of 58670:
*Clinical Responsibility*
First, the provider places the patient in the dorsal lithotomy position. He then preps and drapes the abdomen and  administers a general anesthetic. The provider places a uterine manipulator through the cervix so he can move the uterus around during the surgery. The provider enters the abdominal cavity near the belly button using a Veress needle or an open incision and places a laparoscope. The provider insufflates the abdomen with CO2 gas to create a pneumoperitoneum and then  puts the patient into the Trendelenburg position. He then makes small incisions around the abdominal area to insert trocars to better view the operating site and insert surgical tools.
If the provider is performing robotic surgery, he docks the robot to the laparoscope at this time. The provider identifies each fallopian tube and traces it to its fimbriated (fringelike) end. He then applies high–frequency electric current to the middle of each tube to seal it off; he may cut through the tube at the cauterized site. *The provider may remove a portion of the fallopian tube* to send to pathology. He then irrigates and deflates the abdominal cavity and removes all instruments and trocars. He closes the trocar site fascia and skin and removes all instruments from the vagina.

58661 is valued higher, because more work is typically performed.  It is used for salpingectomy for disease treatment or possibly prophylactic risk reduction surgery.  

ACOG has previously advised that 58670 is the correct code in these situations.  If you have an ACOG membership:


			https://acogcoding.freshdesk.com/support/solutions/articles/5000710150-july-2016-prophylactic-salpingectomies-updated-5-14-2019-


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## ltingle1 (May 28, 2020)

csperoni said:


> You do not specify in your question, but since both codes are laparoscopic, so I will assume the procedure was done laparoscopically.
> If they are only removing a small portion of tube for the purpose of sterilization, 58670 is the correct code.
> Here is the full Supercoder description of 58670:
> *Clinical Responsibility*
> ...



Thank you so much for your response and I appreciate you attaching the article!  This was extremely helpful!


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## ltingle1 (May 28, 2020)

SharonCollachi said:


> Similar recent discussion here.
> 
> More info here.
> 
> ...



Thank you for your response!


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## csperoni (Feb 22, 2022)

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 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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## nielynco (Feb 23, 2022)

csperoni said:


> 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 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                  *
> ...


Good to know.  But as a reminder to all coders, the diagnosis still is sterilization, not a disease condition, and many payers have weighed in on this in the past as 58661 has much higher RVUs than 58670 (19.38 versus 11.09).


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