CPT Code 59120 Excision Procedures for Maternity Care and Delivery

Official CPT® Description (AAPC/AMA): “Surgical treatment of ectopic pregnancy; with salpingectomy and/or oophorectomy, abdominal or vaginal approach.”

CPT code 59120 is reported when the physician surgically treats an ectopic pregnancy, specifically a tubal or ovarian ectopic, by removing the fallopian tube (salpingectomy) and/or ovary (oophorectomy) using either an abdominal or vaginal surgical approach. This is a major, life-saving operation performed when a fertilized egg implants outside the uterus and threatens the patient’s health.

Description of the Procedure

During this procedure, the surgeon accesses the pelvic cavity through an abdominal or vaginal incision to remove the affected fallopian tube and/or ovary that contains the ectopic pregnancy.

The main goals are to stop internal bleeding, remove the abnormal pregnancy, and preserve reproductive and overall health where possible.

This procedure is most often performed in emergency settings due to ruptured or bleeding ectopic pregnancies, but it can also be done electively when imaging confirms a nonviable ectopic gestation.

Key Surgical Steps May Include:

• Making an abdominal (laparotomy) or vaginal incision.
• Identifying the location of the ectopic gestation.
• Removing the affected tube and/or ovary.
• Controlling bleeding and repairing any surrounding structures is necessary.
• Inspecting the contralateral adnexa and uterus for further abnormalities.

This code applies only when organ removal (salpingectomy and/or oophorectomy) is performed. If a conservative treatment like salpingostomy is done, report CPT 59121 instead.

When to Use CPT 59120

Use CPT 59120 when:

• The patient has a confirmed ectopic pregnancy located in the fallopian tube or ovary.
• Surgical removal of the affected organ(s) is necessary to stop bleeding or prevent rupture.
• The approach is abdominal or vaginal, not laparoscopic.
• The procedure involves the removal of tissue (not drainage or simple incision).

For laparoscopic treatment, use CPT 59151 or other applicable laparoscopic ectopic codes.

Key Coding Considerations

• Single Reporting: Use CPT 59120 once per operative session, regardless of unilateral or bilateral removal.
• Global Period: 90 days; postoperative care is bundled.
• Bundling Rules: Do not separately bill for minor procedures (e.g., biopsy, irrigation, or wound closure) performed at the same time.
• Site of Service: Hospital inpatient or emergency surgical suite.
• Prior Authorization: Required by many payers, especially for non-emergency ectopic procedures.

Modifiers

Use modifiers to clarify provider roles or surgical details:

• Modifier 50 – Bilateral procedure (if both adnexa removed).
• Modifier 51 – Multiple procedures in the same session.
• Modifier 54/55 – For split surgical and postoperative care.
• Modifier 59 – Distinct procedural service, when appropriate.
• Modifier RT/LT – To specify laterality for payer clarity.

Documentation Requirements

Precise documentation supports compliance and reimbursement. Include:

• Diagnosis and location of the ectopic pregnancy.
• Operative approach (abdominal or vaginal).
• Organs removed (tube, ovary, or both).
• Estimated blood loss and intraoperative findings.
• Justification for surgery (e.g., rupture, hemorrhage risk).
• Postoperative care plan and follow-up instructions.

Comprehensive notes not only ensure correct coding but also protect against audits and denials.

Reimbursement and Billing Information

CPT 59120 is recognized as a major gynecologic surgery with a 90-day global period.

• Typical Setting: Inpatient hospital or emergency department.
• Reimbursement Basis: Depends on payer and region; generally aligns with major open pelvic surgery rates.
• Prior Authorization: May be waived for emergencies, but is required for scheduled cases.
• Bundled Services: Postoperative care, wound management, and follow-up visits within the global period.

Common Coding Challenges

Coding for ectopic pregnancy surgeries, such as CPT 59120, can be complex because clinical urgency often limits documentation precision. Many denials or delays stem from avoidable issues in operative reporting or code selection. Below are the most frequent challenges and practical solutions:

Incomplete Description of Surgical Approach

Coders often struggle when the operative note doesn’t specify how the surgery was performed. Always confirm whether it was done via abdominal or vaginal approach, as this directly determines the correct CPT code and affects payer classification.

Unclear Organ Involvement

The code 59120 applies only when the fallopian tube and/or ovary are removed. If the note simply says “ectopic pregnancy treated surgically” without specifying the exact organ, coders may inadvertently assign the wrong CPT (e.g., 59121). Encourage providers to clearly document whether a salpingectomy, oophorectomy, or both were performed.

Mixing Conservative and Definitive Procedures

Some providers perform partial removals or conservative procedures to preserve fertility. When documentation does not clarify the intent (complete removal vs. incision and evacuation), coders may confuse 59120 with 59121. The operative summary should clearly describe the extent of tissue excised.

Emergency Setting Documentation Gaps

In emergency cases, operative notes are often completed later or lack key details. Missing information like estimated blood loss, rupture status, or hemodynamic instability can lead to claim denials. Always ensure an addendum or brief summary is added postoperatively to strengthen the claim.

Bundled or Overlapping Services

Coders sometimes overreport procedures already included in the global package, such as wound closure or irrigation. For CPT 59120, postoperative care and related services fall under the 90-day global period and should not be billed separately.

Insufficient Medical Necessity Support

Even though this is often an emergent procedure, payers may still require a clear clinical rationale in elective or scheduled cases. Include the diagnosis of ectopic pregnancy, imaging confirmation, and justification for surgical intervention over medical management.

ICD-10 Coding Guidance

Supportive diagnosis categories for CPT 59120 typically include:

• O00.1 – Tubal pregnancy
• O00.2 – Ovarian pregnancy
• O00.8 – Other ectopic pregnancies
• O00.9 – Unspecified ectopic pregnancy

Ensure the ICD-10 code matches the surgical finding documented in the operative report.

Example Clinical Scenarios

Scenario 1 – Tubal Rupture:

A patient presents to the ER with severe abdominal pain and internal bleeding. Surgery reveals a ruptured tubal ectopic pregnancy. The surgeon performs an abdominal salpingectomy to remove the affected tube. → Report 59120.

Scenario 2 – Ovarian Ectopic Pregnancy:

During exploratory laparotomy, a nonviable ovarian ectopic pregnancy is found. The surgeon removes the ovary and controls bleeding. → Report 59120.

Scenario 3 – Combined Ectopic Surgery:

A patient with an ectopic pregnancy and extensive adhesions undergoes salpingectomy and partial oophorectomy. → Report 59120, with clear documentation of findings and structures removed.

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