Key Words Help Pinpoint Tubal Sterilization Coding

When it comes to these procedure codes, look to technique, approach, method, and timing.

By Lynda Vining, CPC
When coding tubal sterilization procedures, it’s all about the technique, approach, method, and timing. The code descriptions hold the answers, helping you select the correct CPT® code. For example:

• Tubal sterilization may be accomplished by several techniques, including incisional or via hysteroscope or laparoscope.
• Tubal sterilization may be accomplished by several methods such as fulguration, ligation, occlusion, or transection.
• Tubal sterilization can be performed by abdominal, suprapubic, transabdominal, transcervical, or vaginal approach (the approach is not coded separately, but may be a specific component of the procedure).
• Tubal sterilization may be performed at the time of a cesarean delivery or other intra-abdominal surgery, during the same hospitalization as the delivery or other intra-abdominal surgery, but on a different day, or after the hospitalization in which the delivery or other surgery occurred.

CPT^® Codes for Tubal Sterilization

58565     Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants
With this procedure, the physician performs a hysteroscopy with bilateral fallopian tube cannulation and placement of permanent implants, which occlude the fallopian tubes. The physician advances the hysteroscope through the vagina and into the cervical os to gain entry into the uterine cavity, inserting a catheter into each fallopian tube. The catheter delivers a small metallic implant into each fallopian tube. The presence of the obstructive implant causes scar tissue to form, completely blocking the fallopian tube.
Adiana® and Essure® are examples of implants inserted to induce occlusion of the fallopian tubes.
58600     Ligation or transection of the fallopian tube(s), abdominal or vaginal approach, unilateral or bilateral
The physician ties off the fallopian tube or removes a portion of it on one or both sides. The procedure may be done through a small incision just above the pubic hairline.
58605     Ligation or transection of fallopian tube(s), abdominal or vaginal approach, postpartum, unilateral or bilateral during the same hospitalization (separate procedure)
This procedure is done during the same hospital stay as the delivery (except for the episode of care, this code is the same as 58600).
+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)
The physician ties off the fallopian tube, or removes a portion of it on one or both sides, at the time of a cesarean section or intra-abdominal surgery.
This is an add-on code and is not subject to multiple procedure rules. This code is to be used as an add-on code to the primary codes for cesarean delivery, and should never be used as a standalone code.
According to OptumInsight’s Coders’ Desk Reference for Procedures, surgical techniques for the following codes are performed as:
58615     Occlusion of fallopian tube(s) by device (eg, band, clip, Falope ring) vaginal or suprapubic approach
This reversible procedure is performed by either a vaginal or suprapubic approach. The physician blocks one or both fallopian tube(s) with a Silastic band, clip, or fallopian ring. The Falope ring, Yoon ring, Filshie clip, and Hulka clip are examples of devices used for fallopian tube occlusion.
58670     Laparoscopy, surgical; with fulguration of oviducts (with or without transection)
With the assistance of a fiber optic laparoscope, the physician performs laparoscopic electrical cautery destruction of an oviduct with or without completely cutting through the fallopian tubes. The physician may first insert an instrument through the vagina to grasp the cervix and manipulate the uterus during surgery before  making a small incision just below the umbilicus, through which a fiber optic laparoscope is inserted. The physician places additional instruments through a second incision on the left or right side of the abdomen. The physician manipulates the tools so the pelvic organs can be observed, manipulated, and operated on with the laparoscope. To fulgurate the fallopian tubes, the physician inserts an electric cautery tool or a laser through a third incision adjacent to the fallopian tubes. The physician may cut the tubes and fulgurate the ends. The physician may transect the fallopian tubes.
58671     Laparoscopy, surgical; with occlusion of oviducts by device (eg, band, clip, or Falope rings)
The physician may first insert an instrument through the vagina to grasp the cervix and to manipulate the uterus during surgery. Next, the physician makes a small incision just below the umbilicus, through which a fiber optic laparoscope is inserted. A second incision is made on the left or right side of the abdomen. Additional instruments are placed through these incisions into the abdomen or pelvis. The physician manipulates the tools so the pelvic organs can be observed, manipulated, and operated on with the laparoscope. A third incision typically is made adjacent to the fallopian tubes and the devices (Silastic bands, clips, or Falope rings) are applied to the tubes.

Watch for Place of Service

Sterilizations can be performed in the office setting or in an outpatient or inpatient hospital setting. Sterilization procedures are considered to be elective. As such, be sure you verify coverage with the patient’s insurance carrier before scheduling a procedure.
Lastly, some insurance carriers require special informed consent forms to be completed prior to the performance of these services. Check with the patient’s insurance carrier for consent requirements prior to scheduling the procedure.

Separate Procedures

According to the American Medical Association’s (AMA’s) guidelines, any code designated in CPT^® as a “separate procedure” is usually a component of a more complex service or an integral component of another procedure. Such procedures are not reported separately when performed with other procedures and services in an anatomically-related area (e.g., same skin incision, same orifice, or same surgical approach).
It is appropriate to report a code identified as a separate procedure if performed alone, however. If the procedure is performed on the same calendar day as another related procedure, but during a different operative session, report both the separate procedure code and the primary service code and append modifier 59 Distinct procedural service to the separate procedure code.

Add-on Codes

Add-on codes describe additional intra-service work associated with the primary procedure. They are performed on the same day as the primary procedure, and must never be reported as a standalone code. Add-on codes are not subject to multiple procedure rules. Modifier 51 Multiple procedures should not be applied to add-on codes, nor should reimbursement be reduced.
 

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