Overview

CPT 59100 describes a surgical hysterotomy performed via abdominal incision for the removal of the fetus in cases where the uterus is intact and not ruptured. This procedure is generally reserved for pregnancies that cannot continue due to fetal demise or severe maternal complications, but where vaginal or less invasive evacuation methods are not safe or possible. It is not performed for the delivery of a viable term infant that falls under delivery codes.

Because it’s a high-complexity, low-frequency procedure, accurate coding is critical to ensure reimbursement and compliance.

Purpose

This code ensures fair payment for providers performing surgical pregnancy termination through abdominal access when other methods are contraindicated. It protects against revenue loss in rare, emergent situations and documents the clinical necessity for a major abdominal surgery outside the context of live birth.

Clinical Scenarios Where 59100 Is Applicable

Fetal demise where dilation and evacuation are unsafe due to gestational age or uterine condition.
Severe maternal conditions (e.g., placenta previa with active bleeding) where surgical removal minimizes risk.
Failed induction or failed dilation & evacuation requiring surgical abdominal access.

Procedure Overview for 59100

Preoperative: Patient stabilization, anesthesia evaluation, and informed consent with full risk discussion.
Operative: Midline or low transverse abdominal incision; uterus accessed and incision made; fetal and placental tissue removed; uterus and abdominal wall closed in layers.
Postoperative: Recovery monitoring, pain control, and follow-up for wound care and emotional support.
Documentation should include the medical necessity, surgical approach, and patient outcome.

Setting

Typically performed in a hospital operating room under general or regional anesthesia, often in urgent or emergent circumstances.

Documentation Requirements for 59100

Detailed operative report with surgical approach, findings, and indication for abdominal method.
Gestational age and reason for avoiding vaginal evacuation.
Pre- and postoperative diagnosis codes that support medical necessity.
Date and setting of surgery.

Billing and Reimbursement Tips for 59100

Report only when procedure meets definition; not for cesarean deliveries.
Attach appropriate diagnosis codes (e.g., fetal demise, maternal complication).
Be aware of the 90-day global period for major surgery codes—bill related postoperative visits within this timeframe.
Include an operative note with the claim to prevent payer requests for additional documentation.

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Hysterotomy cases, such as CPT 59100, are rare, complex, and highly audited, which means that even a small coding error can result in thousands of dollars in costs. We make sure your surgical maternity billing is airtight from start to finish.

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