Ob-Gyn Coding Alert

Ob/gyn surgeons perform a tubal ligation at the patient's request when she no longer wishes to conceive children. More and more women who have undergone the procedure are looking to tubal ligation reversal as a means of restoring their fertility.
 
Although coding and reimbursement for both procedures can vary from carrier to carrier, reimbursement and diagnostics for tubal ligation depend on whether the procedure was performed as part of another surgery or as an independent elective procedure.
 
When tubal ligation is performed separately from any other procedures or hospitalization, it is coded according to the method used to accomplish the procedure. For example, 58600 (ligation or transection of fallopian tube[s], abdominal or vaginal approach, unilateral or bilateral) and 58615 (occlusion of fallopian tube[s] by device [e.g., band, clip, Falope ring] vaginal or suprapubic approach) apply when a laparoscope is not used during the procedure; 58670 (laparoscopy, surgical; with fulguration of oviducts [with or without transection]) and 58671 (... with occlusion of oviducts by device [e.g., band, clip, or Falope ring]) apply when a laparascope is used.
 
Melanie Witt, RN, CPC, MA, an independent coding educator from Fredericksburg, Va., and an ob/gyn coding expert, says carriers that pay for tubal ligation are generally those that pay for birth control.
 
It is unlikely that a large health maintenance organization or preferred provider organization that does not cover birth control would pay for an elective surgery like tubal ligation.
Delivery Method
Coding for tubal ligation accurately depends on 1) whether the procedure was performed after vaginal or cesarean delivery and 2) whether the physician performed the procedure immediately after the delivery (during the same operative session) or a day or more after the delivery (during the same hospital stay).
 
Vaginal Delivery. Tubal ligation is coded separately when billed with any of the following:

 59400 routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care
 59409 vaginal delivery only (with or without episiotomy and/or forceps)
 59410 ... including postpartum care.
If the tubal ligation occurs immediately after the delivery (during the same operative session), use 58605 (ligation or transection of fallopian tube[s], abdominal or vaginal approach, postpartum, unilateral or bilateral, during same hospitalization [separate procedure]) with modifier -59 (distinct procedural service) appended. Modifier -59 tells the carrier that the tubal ligation was a distinct service from the delivery even though they occurred during the same session. Since the tubal ligation requires a separate incision and is essentially unrelated to the vaginal delivery, carriers that pay for the ligation under other circumstances will generally not take issue with reimbursement using this coding sequence.
 
If the tubal ligation occurs a day or more after the delivery (during the same hospital stay), use [...]