Ob-Gyn Coding Alert

Question: When billing a laparoscopy removal of fallopian tubes only (without the ovary), can you bill 58661 or with this code, do you have to remove the ovary with fallopian tubes? Can I also get your view on the best way to describe the difference between 58670 and 58661? My coder thinks this should be 58661 instead of 58670 because the doctor says: Laparoscopic bilateral salpingectomy.

Maryland 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.

But is this really a case where the physician has done a bilateral salpingectomy to accomplish sterilization? The American Congress of Obstetricians and Gynecologists (ACOG) has published a committee opinion stating that removing the tubes, rather than simply fulgurating/transecting the tubes, reduces the risk of ovarian cancer. If this was done for sterilization rather than removal of disease, you may find that the payer will down-code to the lesser procedure (58661 has 18.50 RVUs while 58670 has 10.35 RVUs). 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)