Ob-Gyn Coding Alert

Question: Our physician performs a bilateral salpingectomy at the same time he performs a c-section. He wants us to bill 59510 and 58700. However, I have never billed it that way. Instead, I have billed 59510 with +58611 because almost all insurance companies deny it for CPT^® and ICD-10 code mismatch. What is the correct way to report these codes? 

Florida Subscriber

Answer: You only have one correct way — report 59510 (Routine obstetric care including antepartum care, cesarean delivery, and postpartum care) and +58611 (Ligation or transection of fallopian tube(s) when done at the time of cesarean delivery or intra-abdominal surgery (not a separate procedure) (List separately in addition to code for primary procedure)). CPT^® cannot be any clearer on this issue.

Also, the American Congress of Obstetricians and Gynecologists (ACOG) published this information also:

Code 58700 (Salpingectomy, complete or partial, unilateral or bilateral (separate procedure)) should never be used to report a sterilization procedure of any sort. This code was valued to include pathological changes of the fallopian tubes that cause complications such as blocked tubes or adhesions.

Not sure why you’re getting an ICD-10/CPT^® mismatch on +58611 if you are using a diagnosis of sterilization, as this is the only purpose of this code. Granted, the reimbursement is less, but that is because your ob-gyn is being paid for the intraoperative portion only (no pre or post op care attached to this code). If you are getting denials on +58611, APPEAL, APPEAL, APPEAL!