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Posted By Jan on 12-20-2017, 19:29:07 in Ob-Gyn
I have
Comments (2)
Posted By Melanie Witt on 12-26-2017, 15:00:20
ACOG did weigh in on this by publishing an opinion as follows. Also note that if you elect to bill 58661 the Dx is sterilization so the payer knows exactly why it was done and can deny appropriately if they are unwilling to pay more for this preventive procedure.

July 2016: Prophylactic Salpingectomies

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.

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.
Posted By Jan on 12-20-2017, 19:33:16
Sorry, here is my question. I have tried to look for archives on this subject of removing fallopian tubes when doing tubal sterilizations and prophylactically when doing hysters. I am unable to find your past articles on this Melanie. Wondering if you could repost again or instruct me on how to find the past articles. Using the OBGYN category and typing salpingectomy as the key word brings up nothing.
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