CPT Code 58670 Laparoscopic Tubal Cautery or Ligation

Laparoscopic tubal sterilization remains one of the most widely performed gynecologic surgeries for permanent contraception. The CPT 58670 code represents the laparoscopic cauterization, fulguration, or mechanical occlusion of the fallopian tubes for sterilization purposes.

Though it may seem straightforward, proper documentation and modifier use are essential, as errors in this area often lead to denied claims or incorrect bundling with other laparoscopic services.

Understanding CPT 58670

Official Definition:

“Laparoscopy, surgical; with fulguration of oviducts (with or without transection).”

This code describes a laparoscopic sterilization procedure where the surgeon uses electrocautery, rings, clips, or other means to occlude or transect the fallopian tubes, preventing future conception.

Key Aspects of CPT 58670:

• Approach: Laparoscopic, minimally invasive.
• Purpose: Permanent female sterilization.
• Technique: Fulguration, coagulation, or mechanical occlusion (with or without transection).
• Scope: Includes diagnostic evaluation of the pelvis during the same session.

Coding Note: If a salpingectomy (removal of the entire fallopian tube) is performed instead of simple cautery or occlusion, report CPT 58661 instead.

When to Use CPT 58670

Use CPT 58670 to report laparoscopic sterilization procedures performed for contraceptive purposes using fulguration or occlusion techniques.

Common Indications Include:

• Patient requests permanent contraception.
• Completion of childbearing.
• Family planning procedure following delivery or abortion (if performed separately).

Do not use CPT 58670 when:

• The procedure involves complete salpingectomy (use 58661).
• It is performed during another major laparoscopic procedure, such as a hysterectomy, where sterilization is incidental.
• Performed via mini-laparotomy (use CPT 58600 instead).

Documentation Requirements

Clear documentation ensures the payer recognizes the sterilization as therapeutic and intentional, not exploratory.

Include the following details in the operative note:

• Confirmation that the procedure was for sterilization.
• Technique used: e.g., bipolar cautery, Filshie clip, or Falope ring.
• Laterality: Both tubes treated (bilateral).
• Method confirmation: Tubal lumen interrupted, occluded, or coagulated.
• Any intraoperative findings (adhesions, anomalies).

Tip: Include the patient’s signed consent for sterilization, especially for Medicaid and federally funded insurance, as it’s required for payment compliance.

Reimbursement and Coverage Information

CPT 58670 has a 90-day global period and is reimbursed as a major laparoscopic procedure.

Average National Reimbursement (Medicare):

• Physician Fee (Facility): $500–$650
• ASC Payment: $1,000–$1,300
• Hospital Outpatient: $1,400–$1,700

Common ICD-10 Codes Supporting Medical Necessity:

• Z30.2 – Encounter for sterilization.
• Z30.09 – Encounter for other contraceptive management.
• Z98.51 – Tubal ligation status (used for postoperative status documentation).

Modifiers for CPT 58670

Use these modifiers when applicable:

• Modifier 59 – For a distinct laparoscopic procedure in the same session.
• Modifier 51 – If multiple surgical procedures were performed.
• Modifier 52 – If incomplete or unilateral procedure.
• Modifiers 54/55 – For split surgical/post-op care billing.

Compliance Reminder: Always append modifier 52 when the sterilization was attempted but could not be completed bilaterally due to adhesions or anatomic limitations.

Example Scenarios

Scenario 1 – Standard Bilateral Tubal Cautery

A 36-year-old woman undergoes elective laparoscopic sterilization. Both fallopian tubes are identified and coagulated with bipolar cautery at two sites each.

→ Report CPT 58670.

Scenario 2 – Incomplete Procedure Due to Adhesions

During the same planned sterilization, severe adhesions prevent visualization of the right tube, and only the left tube is fulgurated.

→ Report CPT 58670-52 (Reduced Service).

Scenario 3 – Tubal Occlusion During Diagnostic Laparoscopy

A diagnostic laparoscopy for pelvic pain incidentally includes bilateral tubal ligation per patient request.

→ Report CPT 58670 (document clear intent and method).

Common Coding Challenges and How to Avoid Them

Sterilization coding appears simple, but a few documentation gaps or modifier mistakes can cause major claim delays. Here’s how to avoid them:

Missing Sterilization Consent

Federal and Medicaid plans require a signed sterilization consent at least 30 days before the procedure. Claims without it are automatically denied.

Tip: Always attach the consent form and confirm compliance with CMS sterilization policy requirements.

Confusion Between Cautery and Salpingectomy

Coders often confuse tubal fulguration (58670) with complete salpingectomy (58661). The former involves coagulation or occlusion, while the latter removes the entire tube.

Tip: Review the operative note for terms like “removed” or “excised” — which indicate 58661 instead.

Bundling with Other Laparoscopic Procedures

When sterilization is performed during another laparoscopic surgery (like ovarian cystectomy), CPT 58670 may be bundled unless it’s distinct.

Tip: Apply Modifier 59 only if documentation supports a separate surgical intent and location.

Incomplete Documentation of Technique

Vague operative notes such as “tubes cauterized” often lead to payer queries.

Tip: Specify the device (Filshie clip, bipolar forceps), the number of occlusion sites, and whether both tubes were treated.

Unilateral or Failed Sterilization

If only one tube is treated due to anatomic issues, the claim must reflect reduced service.

Tip: Use Modifier 52 and describe the reason for incomplete sterilization in the report.

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Coding sterilization procedures like CPT 58670 demands precision in both documentation and payer compliance.

At BillingFreedom, our OBGYN billing experts ensure:

• Every sterilization claim meets consent and documentation standards.
• Correct modifier usage for incomplete or combined procedures.
• Timely and clean claim submission to avoid denials.

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