Ob-Gyn Coding Alert

Question: What is the difference between 58661 and 58670. I have trouble deciding between the two when done for sterilization purposes. What would you code the following to?

Procedure Details The patient was seen in the Holding Room. The risks, benefits, complications, treatment options, and expected outcomes were discussed with the patient. The possibilities of reaction to medication, pulmonary aspiration, perforation of viscus, bleeding, recurrent infection, the need for additional procedures, failure to diagnose a condition, and creating a complication requiring transfusion or operation were discussed with the patient. The patient concurred with the proposed plan, giving informed consent. The patient was taken to the Operating Room, identified as Haley Kerby and the procedure verified as Laparoscopy bilateral salpingectomy. A Time Out was held and the above information confirmed.

After induction of general anesthesia, the patient was placed in modified dorsal lithotomy position where she was prepped, draped, and catheterized in the normal, sterile fashion.

The cervix was visualized and an intrauterine manipulator was placed. A 0.5 cm umbilical incision was then performed. Veress needle was passed and pneumoperitoneum was established. A non-bladed 5mm trochar was inserted through umbilical site. Two additional 5mm trochars were inserted at RLQ and LLQ. The pelvis was inspected, normal uterus, ovaries and fallopian tubes noticed. Ligasure was used to coagulate, cut at mesosalpinx along the entire length of the fallopian tubes. The specimens were passed to pathology. Good hemostasis noticed.

Following the procedure, the three sheath was removed after intra-abdominal carbon dioxide was expressed. The incision was closed with subcutaneous and subcuticular sutures of 4-0 Vicryl. The intrauterine manipulator was then removed.

Instrument, sponge, and needle counts were correct prior to abdominal closure and at the conclusion of the case.

What should we report?

Texas Subscriber

Answer: Code 58661 (Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy)) represents the removal of a tube, an ovary or a tube and ovary on one side (Medicare has considered this a unilateral procedure since 2010). If both fallopian tubes are removed, it would be considered a bilateral procedure and a modifier 50 (Bilateral Procedure) would be applied.

In contrast, 58670 (Laparoscopy, surgical; with fulguration of oviducts (with or without transection)) is a sterilization procedure that involves fulgurating (destroying the segments of the fallopian tube tissue using an electric current) both fallopian tubes, and some techniques also include removing a small length of the tube and then fulgurating the cut ends to seal them.

In general, the work involved when the tubes are removed for sterilization is not the same as that when doing it for disease and therefore many payers are considering the work involved, not the procedure per se in determining what they are willing to pay for when the diagnosis reported is sterilization (Z30.2, Encounter for sterilization). Remember, 58661 has much higher relative value units (RVUs) than 58670 (19.38 versus 11.09). In July 2021, the American Congress of Obstetricians and Gynecologists changed its advice on which code could be billed. This decision is discussed in the article, “5 Tips Take Confusion Out of Your Tubal Ligation Claims,” featured in Ob-gyn Coding Alert, volume 25, number 4.

Bottom line: You should confirm with your individual payers for prior authorization and billing.