CPT Code 58671 Laparoscopic Tubal Block or Occlusion (Device Application)

Permanent sterilization through laparoscopic tubal occlusion is one of the most frequently performed gynecologic procedures worldwide. The CPT 58671 code is used to report laparoscopic application of a mechanical device, such as clips, rings, or bands, to block the fallopian tubes for sterilization.

Though the technique is minimally invasive, proper coding, documentation, and modifier usage are crucial to ensure compliance and correct reimbursement, especially when multiple procedures occur in the same operative session.

Understanding CPT 58671

Official Definition:

“Laparoscopy, surgical; with occlusion of oviducts by device (e.g., band, clip, Falope ring).”

This code is used when the physician performs laparoscopic sterilization by mechanically occluding the fallopian tubes without electrocautery or excision. It typically involves the placement of Filshie clips, Falope rings, or bands over the fallopian tubes to prevent conception.

Key Aspects of CPT 58671:

• Approach: Laparoscopic (surgical).
• Method: Mechanical occlusion using rings, clips, or bands.
• Purpose: Permanent contraception.
• Laterality: Usually bilateral, unless medically limited.

Coding Tip: If the surgeon removes the entire tube (salpingectomy), report CPT 58661, not 58671.

When to Use CPT 58671

CPT 58671 is appropriate when the surgeon performs laparoscopic sterilization using mechanical occlusion methods for contraceptive purposes.

Typical Indications Include:

• Voluntary permanent sterilization after completion of childbearing.
• Contraceptive management for patients desiring permanent birth control.
• Interval sterilization following delivery or miscarriage (if done laparoscopically).

Do not use CPT 58671 when:

• Sterilization involves electrocautery (use 58670).
• Sterilization is performed as part of another major laparoscopic procedure (it may be bundled).
• Tubal occlusion is performed via an open abdominal approach (use CPT 58605).

Procedure Overview

During laparoscopic sterilization, the surgeon introduces a scope and instruments through small abdominal incisions.

Each fallopian tube is identified and gently lifted, and a clip or band is applied around the mid-portion of the tube. This creates a permanent blockage of the lumen, preventing the egg from traveling through.

Mechanical occlusion offers the benefit of preserving surrounding tissue, minimizing thermal injury, and allowing rapid patient recovery.

Documentation Requirements

Accurate documentation is key for reimbursement and audit protection.

Include the following elements in the operative note:

• Confirmation of sterilization intent.
• Device used: e.g., Filshie clip, Falope ring, or band.
• Laterality: Indicate if both tubes were occluded or if the procedure was incomplete.
• Technique and findings: Any complications, anatomic variations, or adhesions.
• Consent verification: Include signed sterilization consent for compliance with federal and payer requirements.

Compliance Reminder: Medicaid and federally funded insurers require a signed sterilization consent form, typically at least 30 days before the surgery.

Reimbursement and Coverage Information

Global Period: 90 days

Typical Setting: ASC or hospital outpatient

Average National Medicare Reimbursement:

• Physician Fee (Facility): $500–$650
• ASC Payment: $1,100–$1,400
• Hospital Outpatient: $1,500–$1,800

Common ICD-10 Codes Supporting Payment:

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

Modifiers for CPT 58671

Use modifiers when necessary to clarify services:

• Modifier 52 – Reduced service (if only one tube occluded).
• Modifier 59 – Distinct procedural service (if separate from other laparoscopic work).
• Modifier 51 – Multiple procedures.
• Modifiers 54 / 55 – For split surgical and postoperative care.

Billing Tip: If adhesions or anatomic barriers prevent bilateral completion, use modifier 52 and include an explanatory note.

Example Scenarios

Scenario 1 – Bilateral Filshie Clip Sterilization

A 32-year-old woman undergoes elective laparoscopic sterilization. Bilateral Filshie clips are applied mid-tubal, with successful occlusion confirmed.

→ Report CPT 58671.

Scenario 2 – Unilateral Tubal Occlusion

During the same procedure, the right tube is occluded with a clip, but dense adhesions prevent left-tubal access.

→ Report CPT 58671-52 (Reduced Service).

Scenario 3 – Combined Diagnostic and Sterilization Procedure

A diagnostic laparoscopy for pelvic pain is expanded when the patient requests sterilization during the same session, and bilateral clips are applied.

→ Report CPT 58671 (ensure clear intent and documentation).

Common Coding Challenges and How to Avoid Them

Sterilization codes like CPT 58671 can lead to errors if documentation or payer rules aren’t followed carefully. Below are common pitfalls and how to prevent them:

Missing or Invalid Sterilization Consent

For Medicaid and federally funded plans, a valid sterilization consent form must be on file. Claims are denied without it.

Tip: Keep a copy of the signed consent in the chart and submit it with the claim when required.

Confusion Between Occlusion and Cautery

Coders sometimes mistake mechanical occlusion (58671) for cautery-based fulguration (58670).

Tip: Review the operative report. If electrocautery or coagulation was used, 58670 applies. If clips or bands were used, report 58671.

Bundling During Combined Laparoscopy

If sterilization is performed during another laparoscopic surgery, such as an ovarian cystectomy or adhesiolysis, some payers may bundle the charge.

Tip: Use modifier 59 only if the sterilization was a distinct, separately intended service.

Incomplete Laterality Documentation

Failure to specify whether both tubes were occluded can cause claim denials or incorrect payment.

Tip: Document “bilateral tubal occlusion with Filshie clips applied” or note unilateral limitation.

Using the Wrong Approach Code

If the surgeon performs the same occlusion technique but via mini-laparotomy, CPT 58605 applies, not 58671.

Tip: Always confirm surgical approach (laparoscopic vs. open).

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