CPT Code 58520 Repair of Ruptured Uterus (Non-Obstetrical)

OBGYN billing often involves procedures that require precise clinical and coding distinctions. CPT code 58520 is one such example, as it applies exclusively to non-obstetrical uterine rupture repairs. Because uterine rupture is commonly associated with childbirth, incorrect coding is a frequent issue, leading to claim denials and reimbursement delays.

Understanding when and how to properly report CPT 58520 is essential for maintaining compliance, supporting medical necessity, and ensuring accurate reimbursement. This guide outlines the definition, appropriate clinical scenarios, modifiers, and billing considerations for CPT 58520.

CPT Code 58520 – Definition and Description

CPT code 58520 is defined as:

Hysterorrhaphy; repair of ruptured uterus (non-obstetrical).

This code represents a surgical procedure to repair a rupture in the uterine wall that is not related to pregnancy, labor, or delivery. The procedure typically involves suturing the damaged uterine tissue to restore integrity, control bleeding, and prevent further complications.

It is important to note that CPT 58520 is strictly limited to non-childbirth-related uterine ruptures. Any rupture occurring during labor, cesarean delivery, or other obstetrical events must be reported using obstetric-specific CPT codes.

Clinical Scenarios Where CPT Code 58520 Is Applicable

CPT 58520 should be reported in the following non-obstetrical situations:

Trauma-Related Uterine Rupture

When the uterus ruptures due to external physical trauma, such as:

• Motor vehicle accidents
• Blunt abdominal or pelvic injury
• Severe physical impact

Example:
A patient involved in a car accident sustains pelvic trauma resulting in a uterine rupture that requires surgical repair.

Rupture Due to Underlying Uterine Disease

Certain conditions can weaken the uterine wall and lead to rupture, including:

• Large or degenerative uterine fibroids
• Severe uterine infections
• Structural uterine abnormalities

Complications From Prior Medical or Surgical Procedures

Non-obstetrical uterine rupture may occur as a complication of:

• Previous gynecologic surgeries
• Instrumentation or invasive procedures
• Post-surgical tissue weakening

In all cases, documentation must clearly establish that the rupture is not related to pregnancy or childbirth.

Modifiers Applicable to CPT Code 58520

Modifiers may be required depending on the complexity of the procedure:

Modifier 22 – Increased Procedural Services

This modifier may be appended when the uterine repair required significantly greater time, effort, or technical difficulty than typically expected.

Use of Modifier 22 must be supported by:

• Detailed operative notes
• Clear explanation of why the procedure was unusually complex

Always verify payer-specific guidelines before submitting modifiers.

CPT Code 58520 – Billing & Reimbursement Guidelines

Accurate billing for CPT 58520 depends on correct coding, strong documentation, and clear medical necessity.

Diagnosis Coding (ICD-10)

CPT 58520 must be paired with ICD-10 diagnosis codes that:

• Indicate non-obstetrical causes such as trauma or disease
• Do not reference pregnancy, labor, delivery, or postpartum status

Using obstetrical diagnosis codes with CPT 58520 is a common reason for claim denial.

Documentation Requirements

To support reimbursement, medical records should include:

• Operative report detailing the cause, location, and extent of the rupture
• Patient medical history confirming the absence of obstetrical involvement
• Clinical findings or imaging supporting the diagnosis

Common Billing Errors to Avoid

• Reporting CPT 58520 for childbirth-related ruptures
• Insufficient documentation of medical necessity
• Mismatched CPT and ICD-10 codes
• Missing operative details

Reimbursement Considerations

Reimbursement varies based on:

• Payer policies
• Place of service
• Geographic location

Because CPT 58520 represents a high-acuity and uncommon procedure, payers often scrutinize claims closely, making accurate coding and documentation especially important.

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Managing complex procedures like CPT Code 58520 for the repair of a ruptured uterus requires expertise in coding and billing. Handling such claims correctly can be time-consuming and prone to errors if not done properly.

By outsourcing your medical billing to BillingFreedom, you can ensure that all claims are submitted accurately, with the right codes and modifiers, improving your revenue cycle. BillingFreedom specializes in OBGYN medical billing services in Nebraska, providing expert support in managing complex claims like CPT 58520, reducing administrative burdens, and helping your practice get paid faster.

Whether you’re dealing with non-obstetrical uterine ruptures or other complicated procedures, we ensure your billing process is streamlined, accurate, and efficient. With us, your practice can focus on what matters most, providing the best care to your patients.

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