Ob-Gyn Coding Alert

Ligations with cesarean deliveries may be an uphill battle -- here's why You can sort through your tubal ligation choices if you zero in on the ob-gyn's technique (laparoscope or hysteroscope versus open procedure), transaction (device or fulguration) method, and delivery involvement. When a patient no longer wishes to conceive children and requests a tubal ligation, you-ve got multiple coding options: a set of codes for procedures performed vaginally or via an open approach, a set of codes for laparoscopic procedures, and a code for Essure tubal ligations. Note: You-ll always report a tubal ligation with V25.2 (Sterilization), no matter which type of tubal ligation the ob-gyn performs or the reason the patient (or patient's legal guardian) requested the tubal, says Melanie Witt, RN, CPC-OGS, MA, an independent ob-gyn coding consultant in Guadalupita, N.M. Did MD Use a Laparoscope? Look to 2 Codes If your ob-gyn uses a laparoscope, you will report either 58670 (Laparoscopy, surgical; with fulguration of oviducts [with or without transection]) for a diathermied tube and 58671 (... with occlusion of oviducts by device [e.g., band, clip, or Falope ring]) if a device occludes the tube. Look out: If an ob-gyn performs a "minilaparoscopic tubal," you will look to these two codes as well, Witt points out -- but look at the technique to determine which code to use. These two codes differ based on technique regardless of whether the ob-gyn performs the ligation on its own or following a delivery. Focus on 4 Options for Open/Vag Procedures If your ob-gyn does not use a laparoscope and performs an open or vaginal procedure, you will report one of these four options: - 58600 -- Ligation or transection of fallopian tube(s), abdominal or vaginal approach, unilateral or bilateral - 58605 -- Ligation or transaction of fallopian tube(s), abdominal or vaginal approach, postpartum, unilateral or bilateral, during same hospitalization (separate procedure) - 58611 -- Ligation or transaction of fallopian tube(s) when done at the time of cesarean delivery or intraab-dominal surgery (not a separate procedure) (list separately in addition to code for primary procedure) - 58615 -- Occlusion of fallopian tube(s) by device (e.g., band, clip, Falope ring) vaginal or suprapubic approach. Keep in mind: Sometimes, physicians refer to a tubal procedure as a "Pomeroy tubal," Witt says. This technique involves tying a section of the tube, then removing it. Your ob-gyn can perform this via laparoscope (58670) or via an open procedure (58600, 58605, 58611). You will not report a device code for this technique. Do This When Ligation Follows Vaginal Delivery You can report the tubal ligations following a vaginal delivery (59400, 59409-59410). If the tubal ligation occurs immediately after the delivery (during the same operative session), [...]