CPT Code 58720 Salpingo-oophorectomy, Complete or Partial, Unilateral or Bilateral (Separate Procedure)

CPT 58720 is used to report an open (abdominal) salpingo-oophorectomy, a surgical procedure in which the surgeon removes one or both ovaries and fallopian tubes. This code represents a therapeutic or prophylactic removal, usually performed to treat conditions like ovarian cysts, malignancies, or severe infections.

Because this is an open laparotomy procedure, it requires accurate documentation to distinguish it from its laparoscopic counterpart (58661). Understanding how to report this code correctly ensures compliance, prevents bundling issues, and supports full reimbursement.

Procedure Description

The surgeon performs an abdominal incision (laparotomy) to access the pelvic cavity. The affected ovary and fallopian tube are then identified, isolated, and surgically excised. The procedure can be unilateral or bilateral, depending on the pathology. The remaining structures are inspected for integrity, and the incision is closed in layers.

This open approach is typically selected for patients with extensive adhesions, large pelvic masses, or suspected malignancy, where laparoscopic surgery may not be appropriate.

When to Report CPT 58720

You should report CPT 58720 when the surgeon performs a therapeutic or prophylactic open removal of one or both ovaries and fallopian tubes.

Common Clinical Indications Include:

• Adnexal mass suspected to be malignant or complex
• Endometriosis involving the ovary and fallopian tube
• Tubal or ovarian abscess due to pelvic inflammatory disease
• Ovarian torsion requiring removal
• Hydrosalpinx or pyosalpinx is not manageable through conservative treatment
• Prophylactic removal in high-risk patients (e.g., BRCA mutation carriers)

Do not report 58720 when:

• The procedure is performed laparoscopically (use CPT 58661)
• Only the fallopian tubes are removed (use CPT 58700)
• A hysterectomy includes adnexal removal, which is bundled into the hysterectomy code

Documentation Requirements

Accurate and complete documentation is the cornerstone of clean claims and audit defense. Operative notes should clearly include:

• Preoperative and postoperative diagnoses
• Indication for surgery (e.g., adnexal mass, infection, prophylaxis)
• Surgical approach – confirmation of laparotomy
• Laterality (unilateral or bilateral)
• Details of structures removed (ovary, tube, or both)
• Intraoperative findings and pathology submission
• Closure details and postoperative plan

Tip: If the procedure is prophylactic, documentation must reference genetic risk (e.g., BRCA mutation) or family history to establish medical necessity.

Reimbursement and Billing Insights

CPT 58720 is categorized as a major surgical procedure with a 90-day global period.

• Typical Setting: Inpatient hospital or surgical center
• Multiple Surgery Rule: Subject to reduction when performed with other major surgeries
• Prior Authorization: Often required for prophylactic or oncologic indications

According to the 2025 Medicare Fee Schedule, reimbursement varies regionally but typically aligns with other major abdominal gynecologic surgeries. Always confirm with payer-specific fee schedules and medical policies.

Common Coding Challenges and How to Avoid Them

Despite being a clearly defined procedure, CPT 58720 often triggers claim denials due to documentation and coding errors. Here are the most frequent challenges and solutions:

Confusing Open vs. Laparoscopic Approach

Coders sometimes misreport 58720 instead of 58661 when the surgeon uses a laparoscope. Since payer reimbursement differs significantly, this mistake can cause claim rejection.

Solution: Confirm operative notes mention laparotomy incision and not “laparoscopic access.”

Bundling with Hysterectomy Codes

When the surgeon removes adnexa during a hysterectomy, 58720 should not be reported separately unless it’s done for a distinct pathology and supported by documentation.

Solution: Only bill separately when operative notes show adnexal removal as an independent, medically necessary procedure.

Missing Laterality or Extent

Failure to indicate whether the removal was unilateral or bilateral leads to underpayment or denials.

Solution: Always document and code accurately; some payers may require modifier 50 for bilateral procedures.

Incomplete Medical Necessity Support

Claims often get denied when the pre-op diagnosis doesn’t clearly justify adnexal removal.

Solution: Ensure clinical notes include imaging, pathology, or prior treatment attempts, establishing necessity.

Incorrect Modifier Use in Combined Procedures

Modifier 59 is frequently misused to bypass NCCI edits when adnexal removal is part of another pelvic surgery.

Solution: Apply Modifier 59 only if the procedures are truly distinct, with separate incisions or pathologies.

ICD-10 Codes Supporting CPT 58720

Proper ICD-10 linkage is essential to demonstrate medical necessity and justify reimbursement for procedures like salpingostomy.
Common diagnostic categories include:

• Ectopic Pregnancy – Used when treating tubal pregnancies or related complications.
   
• Infectious or Inflammatory Disorders – Such as salpingitis, hydrosalpinx, or tubo-ovarian abscess.
   
• Structural or Obstructive Conditions – For tubal blockage or damage affecting fertility.
   
• Prophylactic Indications – For risk-reducing or preventive adnexal surgery.
   

Tip: Always align the diagnosis with the operative indication (therapeutic, emergency, or prophylactic) and confirm payer-specific documentation requirements before submission.

Example Scenarios

Scenario 1 – Therapeutic Removal for Ovarian Torsion

A patient presents with severe pelvic pain; imaging confirms ovarian torsion. The surgeon performs an open salpingo-oophorectomy to remove the necrotic ovary and tube.

→ Bill CPT 58720 with appropriate laterality and diagnosis (N83.511 – Torsion of right ovary and tube).

Scenario 2 – Prophylactic Bilateral Removal (BRCA Positive)

A high-risk patient undergoes elective bilateral salpingo-oophorectomy to reduce cancer risk.

→ Bill CPT 58720 with ICD codes Z40.02 and Z15.01; ensure documentation includes genetic testing confirmation.

Scenario 3 – Combined with Hysterectomy (Separate Pathology)

During a hysterectomy for fibroids, the surgeon removes the left ovary due to a large cyst.

→ Report 58720-59 to indicate a distinct procedure if documentation supports separate pathology.

Why Partner with BillingFreedom For OBGYN Medical Billing Services

Procedures like open salpingo-oophorectomy demand high documentation accuracy and proper code selection to ensure full reimbursement. BillingFreedom specializes in OBGYN medical billing services, helping practices navigate complex surgical coding, eliminate denials, and optimize compliance with CMS and AAPC guidelines.

Our certified coders ensure every claim is audit-ready, supported by clear operative notes, and submitted cleanly for timely payments. So your team can focus on patient care instead of paperwork.

For more details about our exceptional medical billing services, please don't hesitate to contact us via email at info@billingfreedom.com or call us at +1 (855) 415-3472. 

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