The physician ties off the fallopian tube or removes a portion of it on one or both sides. CPT code 58558 Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D&C in reimbursement rate for in-office hysteroscopic biopsy and polypectomy If your practice has a contract based on a: Percentage of Medicare You may potentially receive higher reimbursement for CPT code 58558 in-office else{document.getElementById("usprov").href="/web/"+"jeb"+"/help/us-government-rights";}, Advance Beneficiary Notice of Noncoverage (ABN), Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS), Diabetic, Diabetes Self-Management Training (DSMT) and Medical Nutrition Therapy (MNT), Fee-for-Time Compensation Arrangements and Reciprocal Billing, Independent Diagnostic Testing Facility (IDTF), Medical Documentation Signature Requirements, Supplemental Medical Review Contractor (SMRC), Unified Program Integrity Contractor (UPIC), Provider Outreach and Education Advisory Group (POE AG), PECOS and the Identity and Access Management System, Provider Enrollment Rebuttal, CAPS and Reconsiderations, click here to see all U.S. Government Rights Provisions, Vasectomy, unilateral or bilateral (separate procedure), including postoperative semen examination(s), Ligation or transection of fallopian tube(s), abdominal or vaginal approach, unilateral or bilateral, Ligation or transection of fallopian tube(s), abdominal or vaginal approach, postpartum, unilateral or bilateral, during same hospitalization (separate procedure), 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), Occlusion of fallopian tube(s) by device (eg, band, clip, falope ring) vaginal or suprapubic approach, Laparoscopy, surgical; with fulguration of oviducts (with or without transection), Laparoscopy, surgical; with occlusion of oviducts by device (eg, band, clip, or falope ring), Consistency among the Noridian Jurisdictions. The answer is that the same codes apply: 58670 and 58671. The following procedures, when used for sterilization to prevent reproduction, will be auto-denied due to the absence of a Medicare benefit category. For U.S. Government and other information systems, information accessed through the computer system is confidential and for authorized users only. To obtain comprehensive knowledge about the UB-04 codes, the Official UB-04 Data Specification Manual is available for purchase at 4. Encounter for sterilization 2016 2017 2018 2019 2020 2021 Billable/Specific Code POA Exempt Z30.2 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Add-on codes are not subject to multiple procedure rules. Patient complained of pelvic pain and requested to have the tubal ligation clips removed. Sterilization (NCD 230.3) Page 1 of 3 ... CPT Code Description 55250 Vasectomy, unilateral or bilateral (separate procedure), including postoperative semen examination(s) 58565 Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion CPT cannot be any clearer on this issue. The Evidence of Coverage (EOC) contains specific language excluding sterilization procedures from coverage. The physician may transect the fallopian tubes. Unauthorized or improper use of this system is prohibited and may result in disciplinary action and/or civil and criminal penalties. AMA Disclaimer of Warranties and Liabilities 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. You will need to give the insurance representative both the 5-digit procedure code (s) (58661 and 58700 explained below) and the sterilization diagnostic code. (It may change from year to year.) The procedure may be done through a small incision just above the pubic hairline. 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. if(pathArray[4]){document.getElementById("usprov").href="/web/"+pathArray[4]+"/help/us-government-rights";} The AMA does not directly or indirectly practice medicine or dispense medical services. The ADA is a third-party beneficiary to this Agreement. 58670     Laparoscopy, surgical; with fulguration of oviducts (with or without transection) CPT/HCPCS Codes Code Description 55250 Offices should research coding, coverage, and payment for individual patients since policies and guidelines may vary by payer or health plan. The pessary fitting, (CPT code 57160) may also be used at the time of subsequent encounters under certain circumstances, e.g. 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). No fee schedules, basic unit, relative values or related listings are included in CDT. Users must adhere to CMS Information Security Policies, Standards, and Procedures. Unfortunately, for coders; there is no CPT code for this idea of reporting a prophylactic salpingectomy at athe time of tubal ligation. If an entity wishes to utilize any AHA materials, please contact the AHA at 312-893-6816. • Sterilization of a mentally retarded person where the purpose is to prevent conception, rather than the treatment of an illness or injury. CDT is a trademark of the ADA. End users do not act for or on behalf of the CMS. You acknowledge that the AMA holds all copyright, trademark, and other rights in CPT. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. CPT gives us a code for “salpingectomy” or “tubal ligation” ACOG has given the physicians/surgeons coding options for this type or clinical care and reporting. The physician may first insert an instrument through the vagina to grasp the cervix and to manipulate the uterus during surgery. These codes will no longer be managed through the prior authorization process. Add-on codes describe additional intra-service work associated with the primary procedure. a vasectomy is performed for the purpose of sterilization. Sterilization means any medical procedure, treatment or operation for the sole purpose of rendering an individual permanently incapable of reproducing and not related to the repair of a damaged/dysfunctional body part. 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. CDT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. License to use CPT for any use not authorized here in must be obtained through the AMA, CPT Intellectual Property Services, 515 N. State Street, Chicago, IL 60610. 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). This Agreement will terminate upon notice to you if you violate the terms of this Agreement. For example: 58565     Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants

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