Learn Why Some Payers Still Deny +58661 for Tubal Ligation After a C-Section

When reviewing a tubal ligation claim, the first step is to identify which coding approach is appropriate and whether the procedure can be reported separately.

There are three main coding categories to consider:

• Procedures done through a vaginal or open surgical approach
• Laparoscopic procedures
• Essure tubal ligations

The correct coding depends on several factors:

• The technique used by the physician (laparoscopic, hysteroscopic, or open)
• The method of tubal closure (such as device placement or cauterization)
• Whether the procedure is associated with a delivery

Important note: A tubal ligation should always be reported with code Z30.2 (Encounter for sterilization), regardless of the technique used or the reason for the sterilization request.

Two Coding Options for Laparoscopic Tubal Ligation

When the physician performs a tubal ligation using a laparoscope, the correct code depends on how the fallopian tubes are treated. Use 58670 for procedures where the tube is destroyed with electrocautery or laser, or when it is cut. Use 58671 when a device such as a band, clip, or ring is used to block the tube.

For a “mini laparoscopic tubal,” these same two codes apply. The correct choice depends on the method used, not on whether the procedure is done alone or after a delivery.

History of Laparoscopic Sterilization Coding Updates (CPT 58661 and 58670)

In July 2021, professional coding guidance was updated to state that CPT® 58661 should be used for laparoscopic sterilization procedures when the fallopian tubes are removed. This code Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy), applies when sterilization is achieved through complete or partial removal of the tubes rather than by ligation or placement of clips.

Before this update, in August 2016, the recommendation was to use 58670 for elective laparoscopic sterilizations. However, 58661 could be reported if the tube removal was performed along with another laparoscopic gynecologic procedure that did not involve the adnexa.

Some insurance carriers may question the use of 58661 for sterilization because it carries higher relative value units (RVUs). The appropriate diagnosis remains Z30.2 (Encounter for sterilization) when the purpose of the surgery is sterilization. If the surgery is preventive due to a documented patient history, the diagnosis can instead be Z40.02 (Encounter for prophylactic removal of ovary(s)) and/or Z40.09 (Encounter for prophylactic removal of other organ), with an additional secondary diagnosis explaining the underlying history. In case of a denial, documentation may be needed to show that the level of surgical work matches that of a salpingectomy performed for disease.

Coding Options for Tubal Ligation by Open or Vaginal Approach

When the physician performs a tubal ligation using an open or vaginal method instead of a laparoscope, one of the following four codes applies:

• 58600 – Ligation or transection of the fallopian tubes, abdominal or vaginal approach, unilateral or bilateral.
• 58605 – Ligation or transection of the fallopian tubes, abdominal or vaginal approach, postpartum, unilateral or bilateral, during the same hospitalization (separate procedure).
• +58611 – Ligation or transection of the fallopian tubes performed at the time of a cesarean delivery or another intra-abdominal surgery (not a separate procedure; listed in addition to the primary procedure code).
• 58615 – Occlusion of the fallopian tubes using a device such as a band, clip, or ring, through a vaginal or suprapubic approach.

Important note: Although the guidance for laparoscopic sterilization was revised, the guidance for open procedures remains unchanged. The code 58700 (Salpingectomy, complete or partial, unilateral or bilateral) should not be used for sterilization. This code applies only when the fallopian tubes show pathological changes, such as blockage or adhesions, that require surgical treatment.

How to Code Tubal Ligation After Vaginal Delivery (Use CPT 58605)

Tubal ligation performed after a vaginal delivery, such as those reported with 59400 or 59409–59410, should be coded using 58605 when the procedure is completed immediately following delivery during the same hospitalization.

If the ligation is done during the same operative session as the vaginal delivery, append modifier 51 (Multiple procedures). Since the ligation involves a separate incision and is not directly related to the delivery itself, payers that normally reimburse for the procedure typically do not object when this coding sequence is used.

When the ligation is performed a day or more after delivery, but still within the same hospital stay, report 58605 with modifier 79 (Unrelated procedure or service by the same physician or other qualified healthcare professional during the postoperative period). This coding should allow full reimbursement for the service.

How to Code Tubal Ligation After Cesarean Delivery (+58611)

Use +58611 to report a tubal ligation performed during a cesarean delivery. This situation commonly occurs since the procedure can be completed immediately after childbirth, eliminating the need for a separate surgical session.

However, billing for tubal ligation at the time of a cesarean can be challenging. Many payers consider the cesarean incision to also serve for the ligation, viewing the additional procedure as requiring minimal extra work. Although current policy does not list tubal ligation as a bundled service with cesarean deliveries or global obstetric care, some payers may still provide limited or no additional payment for it.

To help ensure proper reimbursement, practices should review their payer contracts and confirm that tubal ligation performed during a cesarean is reimbursed separately from the global package or cesarean delivery codes. Remember that +58611 is an add-on code and does not require a modifier. Its valuation under the Resource-Based Relative Value Scale (RBRVS) is based solely on intraoperative effort.

Correct Coding for Essure Procedures (CPT 58565)

When sterilization is achieved through placement of permanent implants into the fallopian tubes, report 58565, Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants.

If the implant is inserted in only one fallopian tube (for example, when the other tube is already occluded), append modifier 52 (Reduced services) to 58565 to indicate that the procedure was performed unilaterally.

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Accurate OBGYN medical billing services require in-depth knowledge of complex coding scenarios, including laparoscopic and open tubal ligations, postpartum procedures, and Essure sterilizations. Each service involves distinct CPT codes, modifiers, and payer-specific guidelines that must be applied precisely. BillingFreedom’s billing specialists have extensive technical expertise in these areas, ensuring each claim is correctly coded, fully compliant with current CPT® and ACOG standards, and optimized for accurate reimbursement.

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