58661 for sterilization

metzger130

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Our providers have decided that they are going to do a salpingectomy (58661) for sterilization (z30.2) instead of a tubal ligation. They read information from ACOG that it is the recommended way now. Is anyone else billing these out and getting paid for them? I have the 2020 coding companion for OBGYN and sterilization is not on the list, but not sure if now it is or not. I am also in Ohio. Thank you for any information!
 

Cmama12

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Yes, we do. We began to see providers using 58661 several years ago and after questioning it and a lot of back and forth, leadership decided to accept it. We work our denials and I do not recalling seeing any - can't say that they weren't denied at the beginning, but have not seen any recently for sure.
 

nielynco

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Yes, we do. We began to see providers using 58661 several years ago and after questioning it and a lot of back and forth, leadership decided to accept it. We work our denials and I do not recalling seeing any - can't say that they weren't denied at the beginning, but have not seen any recently for sure.
If you can negotiate with your payer to use 58661 for a preventive procedure be sure you have this in writing. ACOG has published that 58661 is NOT the correct code for a salpingectomy performed for sterilization purposes with one minor exception. In July 2016 they published the following information:

ACOG has recently published Committee Opinion 260, “Salpingectomy for Ovarian Cancer Prevention” January 2015. Per the Committee Opinion, new research indicates that “ovarian cancer may originate in the fallopian tube leading to a window of opportunity for gynecologists offering patients a salpingectomy during benign gynecologic surgeries as one of the few options available for ovarian cancer prophylaxis. Prophylactic salpingectomy may offer clinicians the opportunity to prevent ovarian cancer in their patients”. The Committee Opinion concludes, however, that randomized controlled trials are needed to support the validity of this approach to reduce the incidence of ovarian cancer.

The ACOG Coding Committee has also reviewed this issue and agrees that additional studies will need to be conducted to see if this procedure actually does decrease the risk of ovarian cancer development over time. The approach to performing hysterectomy or sterilization should not be influenced by the theoretical benefit of salpingectomy. Unfortunately, there is not a CPT procedure code for reporting prophylactic salpingectomies. However, surgeons should continue to observe and practice minimally invasive techniques.

Coding Options

When reporting a sterilization procedure during the time of a cesarean delivery, report code 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)).

When performing a laparoscopic salpingectomy in addition to a primary procedure, or at a time of a laparoscopy for a gynecological procedure that does not include the adnexal structures, code 58661 (Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy)) is appropriate. (note that this means other laparoscopic procedures must be performed at this same time so there is usually limited use for code 58661)

When performing an elective sterilization laparoscopically, code 58670 (Laparoscopy, surgical; with fulguration of oviducts (with or without transection)) is appropriate to report.

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.

It is possible that a specific payer will not cover prophylactic procedures or believe them to be medically necessary in spite of the recommendations in the medical literature. Alternatively, some payers may cover the service but the patient's specific plan may not. Documentation must reflect the actual reason for the service even if it is not reimbursed by payers and a specific diagnosis code needs to be linked to the procedure. Diagnosis codes that may be accepted will depend upon specific payer payment policies.
 

Cmama12

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Yes, ACOG recently updated their Committee Opinion "- this Committee Opinion has been updated to include new information on the benefit of salpingectomy for cancer reduction, the feasibility of salpingectomy during vaginal hysterectomy, and long-term follow-up of women after salpingectomy." https://www.acog.org/clinical/clini...tegy-for-epithelial-ovarian-cancer-prevention.



https://www.bcbsil.com/pdf/standards/preventive_services_cpcp.pdf (Procedure code 58661 reimbursable at the preventive level with a diagnosis of Z30.2)
 

csperoni

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UPDATE!!
Even though this thread is older, I know many people research before posting a question that has been asked and answered previously. I was recently corrected that laparoscopic removal of fallopian tubes, even for sterilization is now recommended as 58661 NOT 58670 as previously advised.
https://acogcoding.freshdesk.com/su...gectomy-changes-to-cpt-58661-recommendations- states:

Coding Alert! Laparoscopy: Salpingectomy (Changes to CPT 58661 Recommendations)​

Lisa Satterfield
Modified on: Tue, 27 Jul, 2021 at 12:53 PM

Following a policy analysis of payer coverage and a discussion with the American Medical Association’s CPT Assistant Editorial Board and the CPT Panel’s Executive Committee, ACOG is revising recommendations for the use of CPT 58661: Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy).

ACOG has determined that the evidence validates CPT 58661 for the removal of the fallopian tubes for sterilization laparoscopically, and not the previous recommendation, CPT 58670.

Therefore, ACOG is recommending that CPT 58661 is the appropriate code for the removal of the fallopian tubes for sterilization.

As always, please confirm with individual payers for prior authorization and billing.
 
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Thank you very much Christine for taking care of our OB/GYN specialty Forum!! Thank you for taking care of our Library of knowledge and keeping it updated. It helps all of us to find the correct answers. Thank you. ☺️
 

CAROLBUES

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If you can negotiate with your payer to use 58661 for a preventive procedure be sure you have this in writing. ACOG has published that 58661 is NOT the correct code for a salpingectomy performed for sterilization purposes with one minor exception. In July 2016 they published the following information:

ACOG has recently published Committee Opinion 260, “Salpingectomy for Ovarian Cancer Prevention” January 2015. Per the Committee Opinion, new research indicates that “ovarian cancer may originate in the fallopian tube leading to a window of opportunity for gynecologists offering patients a salpingectomy during benign gynecologic surgeries as one of the few options available for ovarian cancer prophylaxis. Prophylactic salpingectomy may offer clinicians the opportunity to prevent ovarian cancer in their patients”. The Committee Opinion concludes, however, that randomized controlled trials are needed to support the validity of this approach to reduce the incidence of ovarian cancer.

The ACOG Coding Committee has also reviewed this issue and agrees that additional studies will need to be conducted to see if this procedure actually does decrease the risk of ovarian cancer development over time. The approach to performing hysterectomy or sterilization should not be influenced by the theoretical benefit of salpingectomy. Unfortunately, there is not a CPT procedure code for reporting prophylactic salpingectomies. However, surgeons should continue to observe and practice minimally invasive techniques.

Coding Options

When reporting a sterilization procedure during the time of a cesarean delivery, report code 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)).

When performing a laparoscopic salpingectomy in addition to a primary procedure, or at a time of a laparoscopy for a gynecological procedure that does not include the adnexal structures, code 58661 (Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy)) is appropriate. (note that this means other laparoscopic procedures must be performed at this same time so there is usually limited use for code 58661)

When performing an elective sterilization laparoscopically, code 58670 (Laparoscopy, surgical; with fulguration of oviducts (with or without transection)) is appropriate to report.

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.

It is possible that a specific payer will not cover prophylactic procedures or believe them to be medically necessary in spite of the recommendations in the medical literature. Alternatively, some payers may cover the service but the patient's specific plan may not. Documentation must reflect the actual reason for the service even if it is not reimbursed by payers and a specific diagnosis code needs to be linked to the procedure. Diagnosis codes that may be accepted will depend upon specific payer payment policies.
Is it possible for you to attach the ACOG article regarding use of 58670 for sterilization instead of 58661 when bilat salpingectomy is performed. I'm not able to locate the articles and the doctors would like to have proof. carolbues@sbcglobal.net or cbuescher@wregional.com
 

csperoni

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Is it possible for you to attach the ACOG article regarding use of 58670 for sterilization instead of 58661 when bilat salpingectomy is performed. I'm not able to locate the articles and the doctors would like to have proof. carolbues@sbcglobal.net or cbuescher@wregional.com
The advice given by @nielynco in March 2021 was 100% accurate AT THE TIME. The ACOG guidance CHANGED in July 2021 per my post on 02/23/2022. The current (at least of of today) ACOG guidance is 58661 for laparoscopic tube removal for sterilization.

I posted the body of the article advising of the July 2021 change in my 02/23/2022 posting. The link I original included is outdated and has apparently moved. I have no idea where ACOG moved it to. You do need to login to the ACOG Payment & Policy Portal to see some of the articles. https://acogcoding.freshdesk.com/support/home You can register yourself for free. After logging in, try a search for laparoscopic sterilization. I don't see the original article I posted, but there is a more recent article stating the same and referencing the original article and change to previous advice. https://acogcoding.freshdesk.com/support/solutions/articles/64000277776-laparoscopic-tubal-surgeries
FYI - the ACOG Payment & Policy Portal is also where you can submit questions and is an amazing resource.
 

CBLENNIE

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Not all insurance carriers follow the ACOG guidelines on recommended procedures for sterilization, and they are not required to do so under the ACA. Insurance carriers are required to covered FDA approved contraceptives and sterilization procedures for women only and at this time the FDA does not include 58661-Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy) as sterilization procedure. They only list tubal ligations as a covered sterilization procedure for women. Here is a link to the FDA's website regarding contraceptives and sterilization procedures. https://www.fda.gov/consumers/free-publications-women/birth-control.
 
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