Wiki laparoscopic sterilization with removal of a portion of each tube

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Teressa Way

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One of my providers recently performed what he called a laparoscopic bilateral tubal ligation in which he transected and removed a portion of each tube. I coded this as 58670 based on AAPC's Codify description which states he may remove a portion of the tubes to send to pathology. However, the hospital billed this as 58661. I reached out to the hospital but they are sticking with their coding of 58661. In the body of his note he stated that a partial salpingectomy of each tube was performed. I am not sure if that is why the hospital billed as 58661 but Codify's description of 58661 says one or both tubes and/or one or both ovaries are removed. It doesn't say a portion of them. We only bill 58661 for a sterilizations if the entire tube is removed. I have to provide my providers with guidance going forward and want to make sure we are coding their procedures correctly and also preventing very upset patients when they receive their bills. This patient's insurance paid our claim and left no patient responsibility, but she received a $7K bill from the hospital for their charge of 58661. We have done the same procedure many times before billing as 58670 with no issues for our patients, the only difference being the wording in the body of this op note stating "partial salpingectomy" instead of saying "removed a portion of each tube". Thanks for any input on this subject.
 
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Over the years, there has been some change in coding guidance regarding laparoscopic salpingectomy for sterilization. Original guidance was to use 58670 if done for sterilization, even if removing the entire fallopian tube; 58661 was reserved for laparoscopic salpingectomy for disease. Then in July 2021, after review, ACOG determined that 58661 IS appropriate if laparoscopic salpingectomy is done for sterilization. Some modifications to ACOG's guidance was done in August 2022. I believe you must login, but here is that guidance:
The way I interpret their latest revision is that 58670 is most likely the best option for your situation since you state "transection" and only a portion of each tube. I would still recommend 58661 for laparoscopic removal of the entire tube.
You can also ask a coding question to ACOG and even submit the scrubbed op note - I think this would be a great situation to get official advice on, especially if your providers regularly transect and then remove only a portion of tube.
PS - ACOG also acknowledges in that same article that some payors may require 58670 even when performing laparoscopic salpingectomy if done for sterilization.
 
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