Coding for sterilization by salpingectomy

gschrock

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Milford, IN
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My physicians changed their method of doing lap tubal ligations from fulguration 58670 to lap salpingectomy 58661 in 2014. We had problems with insurance denials even through we used sterilization diagnosis code. Physicians agreed they were ok with using 58670 even though they were removing tubes. Our new physician is not comfortable with this. How are other offices coding this?
 

ciarahertzog

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Codes for BTL vs Salpingectomy

I would like to start by saying that I agree with your new physician that I am also not comfortable with billing the 58670 for the 58661 procedure. When my physicians started performing the salp method it took some convincing for them to agree to the 58661 code- but it is the most accurate for the service being performed. We haven't had issues with outright denials with the Z30.2 diagnosis, instead most insurance companies apply the procedure to the patient's deductible vs the 100% coverage for the 58670/58671. So when we quote benefits to the patient prior to the surgery and they are made aware of the 100% coverage vs ded/coins, most choose a method that is covered at 100%.

I have one physician who is adamant that other OBGYNs she knows are getting their salpingectomies covered at 100% and she doesn't understand why ours aren't. I have a feeling other offices, like yours, are billing the old codes still. The issue we have run into with this is that regardless of how we bill, the hospital still bills the correct 58661 code and their charge goes towards the patient's deductible, even if our charge is covered at 100%. Which ultimately isn't fair to the patient if she didn't know she was going to be meeting her deductible and thought everything would be covered at 100%.
 

LynaeH

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This is our exact issue too- the facility is coding the 58661 per the documentation, which is not covered at 100% for sterilization like 58670/58671. Does anyone have a list of the exact cpt codes that are mandated to be covered at 100% per the ACA guidelines?
 
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