Learn Why Some Payers Still Deny +58661 for Tubal Ligation After a C-Section
Get clear guidance on when you can — and can’t — report it separately. Reviewing a tubal ligation claim? The first step is determining which coding path applies — and whether the procedure qualifies as separately reportable. Your coding choices are: The key to solving these claims is focusing on the following: Heads up: You’ll always report a tubal ligation with Z30.2 (Encounter for 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, MA, an ob-gyn coding expert based in Guadalupita, New Mexico. You Have 2 Options for Ligation by Laparoscope If your ob-gyn uses a laparoscope, you will report 58670 (Laparoscopy, surgical; with fulguration of oviducts (with or without transection)) if the tube is destroyed using electrocautery or laser or is cut in two and 58671 (... with occlusion of oviducts by device (eg, band, clip, or Falope ring)) if a device occludes the tube. If an ob-gyn performs a “mini laparoscopic 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. Check Out This Historical Context In July 2021, the American College of Obstetricians and Gynecologists (ACOG) changed its recommendation for a laparoscopic sterilization to include the statement: “ACOG has now determined that the evidence validates CPT® 58661 for the removal for the fallopian tubes for sterilization laparoscopically.” Therefore, ACOG recommends that 58661 (Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy)) is the appropriate code to report when sterilization is accomplished by removal of the fallopian tubes rather than by ligation or the use of clips. In August 2016, ACOG had indicated “When performing an elective sterilization laparoscopically, code 58670 is appropriate to report.” It added, however, that if the tubes were being removed in addition to some other primary or laparoscopic gynecological procedure that did not involve the adnexa, 58661 could be billed. Some payers “may push back on billing 58661 for a sterilization procedure, because the relative value units [RVUs] are higher. This will not be lost on payers,” Witt says. “You will still have to use the diagnosis of sterilization [Z30.2] if the primary reason for the surgery is sterilization. If, instead, the surgery is required for prophylactic removal of the tubes due to a patient history that has been documented in the medical record, you can report a diagnosis code of Z40.02 [Encounter for prophylactic removal of ovary(s)] and/or Z40.09 [Encounter for prophylactic removal of other organ] instead. For completeness, you would want to add a secondary code for the patient history that led to this decision. If denied, you may have to show that the work involved was equivalent to that of a salpingectomy for disease.” Examine the 4 Options for Ligation by Open/Vaginal Approach If your ob-gyn does not use a laparoscope and performs an open or vaginal procedure, you will report one of these four options: Important tip: While ACOG revised its statement about the laparoscopic approach, its 2016 opinion with regard to the open approach has not changed. Back in 2016, it stated, “Code 58700 [Salpingectomy, complete or partial, unilateral or bilateral (separate procedure)] should never be used to report a sterilization procedure of any sort. This code was valued to include pathological changes of the fallopian tubes that cause complications such as blocked tubes or adhesions.” Use 58605 to Report Ligation Following 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 hospitalization as the delivery), use 58605, experts say. If the tubal ligation is performed at the same operative session as a vaginal delivery, you should append modifier 51 (Multiple procedures). Good news: Because the tubal ligation requires a separate incision and is essentially unrelated to the vaginal delivery, carriers that pay for the ligation under other circumstances will generally not take issue with reimbursement using this coding sequence. However, if the tubal ligation occurs a day or more after the delivery (during the same hospital stay), use 58605 with modifier 79 (Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period). You should receive full reimbursement for the procedure. Check Out +58611 for Ligation Following C-Section You’ll report +58611 for a ligation following a cesarean. Cesarean delivery frequently offers the ob-gyn the chance to perform tubal ligation immediately after the delivery, sparing the patient an additional surgical session. Billing for tubal ligation at the time of cesarean is almost always a problem with payers because they count the cesarean incision as the incision for the ligation, Witt says. To these payers, the ligation at the same session does not represent significant effort for the ob-gyn. Although ACOG specifically leaves tubal ligation off the list of bundled procedures in its policy on cesarean deliveries and global ob care with cesarean, some carriers will pay little or nothing extra for the procedure, Witt says. Money saver: Tubal ligation performed at the time of cesarean delivery can prove a significant source of revenue, so practices should negotiate contract renewal to see that the procedure is reimbursed separately from the global package or cesarean delivery codes. “Also, you should point out to the payer that +58611 is an add-on procedure that does not take a modifier,” Witt explains. The Resource-Based Relative Value Scale (RBRVS) valued this code based solely on the intraoperative work. Zero In on 58565 for Essure Procedure Your ob-gyn can also perform an Essure procedure, which involves implants into the fallopian tubes. For this procedure, you’ll use 58565 (Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants). Note: If the ob-gyn placed the device in only one tube (for instance, if the other tube was already blocked), you should add modifier 52 (Reduced services) to this code. Suzanne Burmeister, BA, MPhil, Medical Writer and Editor
