Permanent contraception or sterilization is on the rise following the ban on abortion and the overruling of Roe v. Wade in 2022. However, billing for these is surrounded by strict compliance rules. These include obtaining a patient’s signed consent form and a waiting period of at least 30 days.
This guide will discuss one of these sterilization procedures covered under CPT code 58670. Besides, we will share a detailed documentation checklist to help you fulfill requirements for pre-procedure, operative notes, and medical necessity.
Thus, if you are a gynecologist struggling to get paid for laparoscopic tubal ligation, continue reading!
CPT Code 58670 – Description
CPT code 58670 covers a laparoscopic tubal ligation, i.e., a permanent sterilization procedure. It involves fulgurating both fallopian tubes with or without transection to prevent future pregnancies.
For context, fulguration is a technique to destroy (seal off) segments of fallopian tube tissue using electric current. Besides, transection involves cutting them in half through a laparoscope.
Scenarios Where CPT Code 58670 is Applicable
Go through the following real-world clinical scenarios to better understand the application of CPT 58670:
Interval Tubal Ligation (Planned Sterilization)
Picture a 37-year-old female patient who has completed her family and requests permanent contraception. She is healthy, not pregnant, and selected laparoscopic tubal ligation (CPT code 58670) after thorough counseling.
Thus, the gynecologist makes two small incisions at the umbilicus and in the lower abdomen. After identifying the fallopian tubes, he seals them with electrocautery near the isthmic portion. Finally, the physician cuts them in half to ensure full separation and permanent contraception.
Sterilization Due to High-Risk Pregnancy
Consider a 40-year-old female patient with a serious cardiac condition that makes any future pregnancies high-risk.
After having a detailed discussion, the cardiologist and gynecologist agree that permanent sterilization is medically necessary. Therefore, the gynecologist performs laparoscopic sterilization using fulguration and transection.
Here, the gynecologist will report CPT code 58670 to bill for the service.
Post-Partum Sterilization (Delayed)
Imagine a 27-year-old female patient who delivered a healthy baby girl vaginally three weeks ago. However, before going into labor, she had requested the OBGYN to perform sterilization to prevent future pregnancies. But the OBGYN was unable to perform the procedure immediately after delivery.
Thus, she returns to the clinic after three weeks. The OBGYN fulgurates and transects both fallopian tubes laparoscopically.
Here, CPT code 58670 applies.
Applicable Modifiers for CPT Code 58670
Discussed below are the applicable modifiers related to CPT 58670:
Modifier 51
What happens when a physician performs another laparoscopic procedure during the same surgical session as an elective sterilization (CPT code 58670)?
You append modifier 51 to highlight to the payer that multiple laparoscopic procedures from the same family were rendered by the same physician in the same operative session.
Modifier 62
It indicates that two surgeons worked together as primary surgeons (co-surgeons) to perform each distinct, significant portion of a surgery.
For example, if in an extremely unlikely case, the vascular surgeon and the gynecologist are both present to perform their respective roles. That is, the vascular surgeon retracts and monitors major blood vessels that are intertwined with the fallopian tubes, while the gynecologist performs the complex laparoscopic tubal ligation.
In this case, both will report CPT code 58670 but with modifier 62.
CPT Code 58670 – Billing & Reimbursement Guidelines
Bid farewell to denials and delayed payments by understanding the essential billing requirements related to CPT 58670:
Fulfill Documentation Requirements
Detailed documentation is essential to ensure the timely processing of claims for laparoscopic tubal ligation:
Pre-Sterilization Requirements (Patient Consent)
Specifically, the federal program Medicare and state-level Medicaid mandate you to prove that the decision for permanent contraception was voluntary and informed.
Thus, you should ensure to include the following details in your documentation:
- Explicitly state that you comprehensively counseled the patient on the procedure’s risks, benefits, and alternatives.
- Confirm that the patient understood that the sterilization covered under CPT code 58670 is permanent and irreversible.
- Attach a signed sterilization consent form (if applicable).
- Mention that at least 30 days passed between the date the patient signed the consent form and the date the physician performed sterilization.
Note: There is an exception to the 30-day waiting period for premature delivery/emergency hysterectomy.
Operative Notes Requirements
Document the details below in your CPT code 58670 operative notes:
- Mention the laparoscopic approach that the physician utilized.
- Explain the technique for occlusion, i.e., fulguration or transection.
- Confirm that the physician sealed off both the oviducts.
Medical Necessity Requirements
The ICD-10-CM code must align with the purpose of performing the laparoscopic tubal ligation (CPT code 58670):
- If the sterilization is elective, use Z30.2, which describes the encounter for sterilization as the primary diagnosis code.
- In case the sterilization is medically indicated due to severe health risks, the underlying medical condition should be the primary diagnosis.
Do NOT Report 58670 if Sterilization is Performed Immediately After Delivery
You may encounter scenarios where you have to tie off one or both fallopian tubes immediately after the delivery. When this happens, you cannot use CPT code 58670. The reason is simple: there are other, more appropriate procedural codes available to choose from:
- CPT code 58605: Sterilization immediately after vaginally delivering a baby.
- CPT code 58611: Sterilization immediately after delivering the baby via a cesarean.
Understand the Difference Between CPT Codes 58661 and 58670
CPT 58661 covers the removal of one or both fallopian tubes and one or both ovaries, or a combination of both, using a laparoscope. Contrarily, CPT code 58670 involves fulgurating both fallopian tubes with or without transection.
That is, they are entirely different codes and should never be billed together.
Summary
This guide offered a roadmap to help you steer clear of audit risk due to non-compliance. All you need to do is follow the reimbursement guidelines we discussed for CPT code 58670, and hopefully, you will get a clean chit for reimbursement.
Here’s a quick summary: (1) Counsel the patient on the risks, benefits, and alternative procedures for sterilization. (2) Obtain a signed consent form to include in documentation. (3) Prepare detailed operative notes. (4) Use an appropriate ICD-10-CM code.
In case you struggle with non-payments despite following the guidelines we explained, outsource OBGYN billing services to a professional like MediBillMD.
