CPT Code 59151 Excision Procedures for Maternity Care and Delivery

Official CPT® Description (AAPC/AMA): “Laparoscopic treatment of ectopic pregnancy; with salpingectomy and/or oophorectomy.”

CPT 59151 is used to report the laparoscopic surgical treatment of an ectopic pregnancy in which the affected fallopian tube and/or ovary is removed. This procedure is performed to resolve a potentially life-threatening condition where a fertilized egg implants outside the uterine cavity, commonly in a fallopian tube, and poses a high risk of rupture and internal bleeding.

Description of the Procedure

The laparoscopic approach represents a minimally invasive alternative to open surgery for treating ectopic pregnancies. Using a laparoscope, a slender instrument equipped with a light and camera, the surgeon visualizes the pelvic organs, locates the ectopic gestation, and removes the affected tissue or organ.

In cases where the tube or ovary has ruptured or sustained irreversible damage, a salpingectomy (removal of the fallopian tube) and/or oophorectomy (removal of the ovary) is performed. The laparoscopic technique typically allows for faster recovery, less blood loss, and reduced postoperative pain compared to open abdominal procedures.

The procedure involves:

• Inserting trocars and a laparoscope through small incisions in the abdomen.
• Identifying the ectopic site (tubal or ovarian).
• Removing the affected fallopian tube and/or ovary using electrocautery or other instruments.
• Controlling bleeding and inspecting remaining reproductive structures.
• Closing incision sites after verifying hemostasis.

When to Use CPT 59151

Report CPT 59151 when:

• The physician treats an ectopic pregnancy laparoscopically.
• The procedure involves the removal of the fallopian tube and/or ovary.
• The pregnancy cannot be preserved, or conservative management is not possible.
• The approach is laparoscopic, not open (which would instead be reported with CPT 59120).

Do not use this code when only incision and evacuation (salpingostomy) are performed; those are coded separately using CPT 59150.

Key Coding Considerations

Because CPT 59151 represents a definitive laparoscopic procedure, careful coding and documentation are critical:

• Global Period: 90 days.
• Site of Service: Hospital inpatient, outpatient surgery center, or emergency department.
• Bundled Services: Includes postoperative care and wound closure within the global period.
• Prior Authorization: Required for planned (non-emergent) cases.
• Multiple Procedures: Apply modifier 51 when performed with additional laparoscopic interventions.

Modifiers

Commonly used modifiers include:

• Modifier 50 – Bilateral procedure.
• Modifier 51 – Multiple procedures, same session.
• Modifier 54 – Surgical care only.
• Modifier 55 – Postoperative management only.
• Modifier 59 – Distinct procedural service, when applicable.
• Modifier LT/RT – To indicate laterality, if required by payer.

Documentation Requirements

Operative documentation for CPT 59151 should clearly support the laparoscopic approach and the surgical extent.

Key components include:

• Diagnosis and location of the ectopic pregnancy (tubal, ovarian, etc.).
• Operative approach: Confirmed as laparoscopic.
• Specific organs removed: Fallopian tube, ovary, or both.
• Intraoperative findings: Rupture status, hemorrhage, and pelvic adhesions.
• Justification for organ removal rather than conservative management.
• Estimated blood loss and postoperative condition.

Proper documentation strengthens claim approval and ensures the service is reimbursed at the correct surgical level.

Reimbursement and Billing Information

CPT 59151 is categorized as a major laparoscopic surgical procedure under the global surgical package.

• Global Period: 90 days.
• Setting: Hospital or ambulatory surgery center.
• Average Reimbursement: Aligned with other major laparoscopic pelvic surgeries (subject to payer region).
• Authorization: Often required for non-emergent cases; emergency cases are typically exempt.
• Multiple Surgery Reduction: May apply when reported with other major laparoscopic codes.

Always verify payer policies for laparoscopic ectopic pregnancy procedures before claim submission.

Common Coding Challenges (CPT 59151)

Coding laparoscopic ectopic pregnancy procedures comes with subtle but high-impact pitfalls. Here’s how to recognize and avoid them:

Vague Operative Documentation

Surgeons sometimes note only “laparoscopic removal of ectopic pregnancy” without specifying which organ was removed. Always ensure the record clearly states salpingectomy, oophorectomy, or both. This detail defines the CPT selection.

Mix-Up Between CPT 59150 and 59151

Coders often confuse 59150 (conservative laparoscopic treatment) with 59151 (definitive removal). The difference hinges on whether the organ was preserved or removed entirely, confirming the surgeon’s intent.

Unclear Approach Confirmation

When the note fails to mention trocars, laparoscopes, or port placement, payers may challenge that the approach was truly laparoscopic. Always verify that laparoscopic visualization is explicitly documented.

Global Period Overlaps

Postoperative care, wound checks, and related minor procedures fall within the 90-day global period. Avoid unbundling or separately billing for included services.

Incomplete Medical Necessity Justification

Even though ectopic pregnancies are emergencies, some payers still require clear clinical reasoning, such as rupture, internal bleeding, or failed medical management, to approve payment. Support the claim with diagnostic imaging and operative findings.

ICD-10 Coding Guidance

Typical ICD-10 diagnosis categories supporting CPT 59151 include:

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

Ensure diagnosis coding reflects the actual anatomic site and surgical findings for maximum claim accuracy.

Example Clinical Scenarios

Scenario 1 – Ruptured Tubal Ectopic (Emergency Case)

A 29-year-old presents with acute abdominal pain and internal bleeding. Laparoscopic exploration confirms a ruptured left tubal ectopic pregnancy. The surgeon removes the left fallopian tube.

Code: CPT 59151 (laparoscopic salpingectomy for ectopic pregnancy).

Scenario 2 – Ovarian Ectopic Pregnancy (Definitive Management)

A 32-year-old with a diagnosed ovarian ectopic undergoes laparoscopic removal of the ovary containing the gestation.

Code: CPT 59151 (laparoscopic oophorectomy for ectopic pregnancy).

Scenario 3 – Bilateral Tubal Involvement (Complex Case)

A patient with severe pelvic adhesions and bilateral ectopic gestations undergoes laparoscopic removal of both fallopian tubes.

Code: CPT 59151-50 (bilateral laparoscopic salpingectomy).

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