58600     Ligation or transection of the fallopian tube(s), abdominal or vaginal approach, unilateral or bilateral Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare and Medicaid Services (CMS). CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. LICENSE FOR USE OF "PHYSICIANS' CURRENT PROCEDURAL TERMINOLOGY", (CPT) If you choose not to accept the agreement, you will return to the Noridian Medicare home page. They will be managed by submission of the following: A. Earn CEUs and the respect of your peers. Reproduced with permission. Note: The information obtained from this Noridian website application is as current as possible. CMS Disclaimer With the assistance of a fiber optic laparoscope, the physician performs laparoscopic electrical cautery destruction of an oviduct with or without completely cutting through the fallopian tubes. Filshie clip (titanium clip) 3. The scope of this license is determined by the AMA, the copyright holder. End users do not act for or on behalf of the CMS. 1. It is appropriate to report a code identified as a separate procedure if performed alone, however. For U.S. Government and other information systems, information accessed through the computer system is confidential and for authorized users only. UPDATED STERILIZATION CODES EFFECTIVE JUNE 1, 2020 Effective June 1, 2020 Aetna Better Health of Pennsylvania will change the way sterilization related CPT and HCPCS codes are reviewed and paid. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This system is provided for Government authorized use only. This license will terminate upon notice to you if you violate the terms of this license. Warning: you are accessing an information system that may be a U.S. Government information system. Code Description It has been estimated that more than 340,000 sterilization procedures are performed in the postpartum period annually in the United States, which accounts for sterilization after 8−9% of all live births. © 2020 Noridian Healthcare Solutions, LLC Terms & Privacy. All rights reserved. The method Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. BY CLICKING ABOVE ON THE LINK LABELED "I Accept", YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THESE AGREEMENTS. CMS DISCLAIMER. To license the electronic data file of UB-04 Data Specifications, contact AHA at (312) 893-6816. code 54699 is the correct code to report an unlisted procedure of the male genital system.-26. The Falope ring, Yoon ring, Filshie clip, and Hulka clip are examples of devices used for fallopian tube occlusion. CPT codes, descriptions and other data only are copyright 2002-2020 American Medical Association (AMA). With this procedure, the physician performs a hysteroscopy with bilateral fallopian tube cannulation and placement of permanent implants, which occlude the fallopian tubes. Tubal sterilization may be performed at the time of a cesarean delivery or other intra-abdominal surgery, during the same hospitalization as the delivery or other intra-abdominal surgery, but on a different day, or after the hospitalization in which the delivery or other surgery occurred. ADA DISCLAIMER OF WARRANTIES AND LIABILITIES. This warning banner provides privacy and security notices consistent with applicable federal laws, directives, and other federal guidance for accessing this Government system, which includes all devices/storage media attached to this system. For 2019, the sterilization diagnostic code is Z30.2. If this is a U.S. Government information system, CMS maintains ownership and responsibility for its computer systems. Sterilization ICD-9-CM V25.2 is a billable medical code that can be used to indicate a diagnosis on a reimbursement claim, however, V25.2 should only be used for claims with a date of service on or before September 30, 2015. The ADA does not directly or indirectly practice medicine or dispense dental services. The physician may transect the fallopian tubes. When coding tubal sterilization procedures, it’s all about the technique, approach, method, and timing. We are looking for thought leaders to contribute content to AAPC’s Knowledge Center. This Agreement will terminate upon notice to you if you violate the terms of this Agreement. These codes will no longer be managed through the prior authorization process. Hulka-Clemens clip 4. The physician ties off the fallopian tube or removes a portion of it on one or both sides. Before you can enter the Noridian Medicare site, please read and accept an agreement to abide by the copyright rules regarding the information you find within this site. According to the American Medical Association’s (AMA’s) guidelines, any code designated in CPT® as a “separate procedure” is usually a component of a more complex service or an integral component of another procedure. If my physican does a Fimbiectomy for sterilization what code do I need to use ? The CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. In addition, he performs a sterilization procedure immediately after the C-section. Also ACOG published this information also: Code 58700 (Salpingectomy, complete or partial, unilateral or bilateral (separate procedure)) should never be used to report a sterilization procedure of any sort. Any communication or data transiting or stored on this system may be disclosed or used for any lawful Government purpose. But what if the documentation refers to a “minilaparoscopic tubal”? The code descriptions hold the answers, helping you select the correct CPT® code. 58615     Occlusion of fallopian tube(s) by device (eg, band, clip, Falope ring) vaginal or suprapubic approach They are performed on the same day as the primary procedure, and must never be reported as a standalone code. During tubal ligation, the fallopian tubes are cut, tied or blocked to permanently prevent pregnancy.Tubal ligation prevents an egg from traveling from the ovaries through the fallopian tubes and blocks sperm from traveling up the fallopian tubes to the egg. The sole responsibility for the software, including any CDT and other content contained therein, is with (insert name of applicable entity) or the CMS; and no endorsement by the ADA is intended or implied. You, your employees and agents are authorized to use CPT only as contained in the following authorized materials: Local Coverage Determinations (LCDs), training material, publications, and Medicare guidelines, internally within your organization within the United States for the sole use by yourself, employees and agents. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a)(June 1995) and DFARS 227.7202-3(a)June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department Federal procurements. The physician advances the hysteroscope through the vagina and into the cervical os to gain entry into the uterine cavity, inserting a catheter into each fallopian tube. re-fitting the patient with a different size or type of pessary. No portion of the AHA copyrighted materials contained within this publication may be copied without the express written consent of the AHA. The procedure was performed via Mini Laparotomy. For example: 58565     Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants The scope of this license is determined by the ADA, the copyright holder. Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CCDS, and Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, discuss coding guidelines and use case studies to illustrate rules for reporting certain OB/GYN codes. There are times in which the various content contributor primary resources are not synchronized or updated on the same time interval. By continuing beyond this notice, users consent to being monitored, recorded, and audited by company personnel. Coding and reimbursement for sterilization has more to it than simply applying the CPT code, diagnosis code, submitting the claim and “voila” having the reimbursement dollars magically appear in the revenue stream. Turn to V25.x for your diagnosis code option. LICENSE FOR NATIONAL UNIFORM BILLING COMMITTEE ("NUBC"), Point and Click American Hospital Association Copyright Notice, Copyright © 2020, the American Hospital Association, Chicago, Illinois. License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. The 2021 edition of ICD-10-CM Z30.2 became effective on October 1, 2020. Add-on codes are not subject to multiple procedure rules. The physician manipulates the tools so the pelvic organs can be observed, manipulated, and operated on with the laparoscope. Operative notes for OB/GYN procedures can be long and complex, and coders need to know how to sift through the detailed information to ensure accurate code assignment. But choosing the proper codes to report can sometimes prove very challenging, right from the pre-vasectomy “consultation” visit that most urologists perform. IF YOU DO NOT AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK ABOVE ON THE LINK LABELED "I Do Not Accept" AND EXIT FROM THIS COMPUTER SCREEN. false. The physician blocks one or both fallopian tube(s) with a Silastic band, clip, or fallopian ring. var url = document.URL; Prior authorization is not required for sterilization procedures; however, an inpatient admission specifically for a sterilization procedure must be prior authorized. Studies have demonstrated that rates of regret after tubal sterilization range from 0.9 to 26% and that these rates are highest in women who are younger at the time of the sterilization procedure. Sterilization (NCD 230.3) Page 1 of 3 ... CPT Code Description 55250 Vasectomy, unilateral or bilateral (separate procedure), including postoperative semen examination(s) 58565 Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion Patient complained of pelvic pain and requested to have the tubal ligation clips removed. 2. You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. Add-on codes describe additional intra-service work associated with the primary procedure. Female sterilization, also called tubal occlusion or ligation, is a permanent contraceptive method for women who do not want more children. sterilization when reimbursed utilizing DRG methodology. The AMA is a third-party beneficiary to this license. You will need to give the insurance representative both the 5-digit procedure code (s) (58661 and 58700 explained below) and the sterilization diagnostic code. Join AAPC’s Author Panel - Be Recognized, on Key Words Help Pinpoint Tubal Sterilization Coding, Key Words Help Pinpoint Tubal Sterilization Coding, I Am AAPC: Marco Unzueta, CPC, CIC, CDEO, CCS, Establish New CPT® Evaluation & Management Rules for 2012, Make the 2012 OIG Work Plan Work for You, Successfully Implement a New Computer System. CPT cannot be any clearer on this issue. LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT"). Learn cpt code medicine with free interactive flashcards. The presence of the obstructive implant causes scar tissue to form, completely blocking the fallopian tube. Sterilizations can be performed in the office setting or in an outpatient or inpatient hospital setting. Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah, Washington, Wyoming. ICD-10-CM code Z30.2, sterilization should be noted in Item 24E of the CMS-1500 claim form or the electronic equivalent: Last Updated Fri, 27 Oct 2017 12:28:08 +0000. ICD-10 Diagnoses Codes (phasing in by September 2014) Z30.9 Contraceptive management, unspecified Z30.8 Encounter for other contraceptive management (applicable to post-vasectomy sperm count) Z30.09 Encounter for other general counseling and advice on contraception Z30.2 Encounter for sterilization Z30.40 Encounter for surveillance of contraceptives, unspecifed Z98.52 Sterilization … According to OptumInsight’s Coders’ Desk Reference for Procedures, surgical techniques for the following codes are performed as: Unauthorized or improper use of this system is prohibited and may result in disciplinary action and/or civil and criminal penalties. Other coding guidance resources have stated that CPT code 58661 would be reported for a disease process and CPT code 58670 would be reported for sterilization. Any questions pertaining to the license or use of the CPT must be addressed to the AMA. This procedure is done during the same hospital stay as the delivery (except for the episode of care, this code is the same as 58600). Such procedures are not reported separately when performed with other procedures and services in an anatomically-related area (e.g., same skin incision, same orifice, or same surgical approach). A second incision is made on the left or right side of the abdomen. An outpatient or inpatient hospital setting knowhow and expertise a common abbreviation for a procedure... Reproduction, will be auto-denied due to the member contract language for benefit.! Shall not remove, alter, or fallopian ring that your employees and agents abide by AMA! Including incisional or via hysteroscope or laparoscope Z302 to bill for sterilization ownership and RESPONSIBILITY its... Beyond this notice, users consent to being monitored, recorded, and must never be reported a! And CONDITIONS CONTAINED in these AGREEMENTS comprehensive Knowledge about the UB-04 codes ICD-10! `` Latest Updates '' every Tuesday and Friday for any LIABILITY ATTRIBUTABLE end! Criminal penalties or indirectly practice medicine or dispense Dental services criminal penalties I need to use ''! Unit, relative values or related listings are included in CPT and vasectomy the! Centers for Medicare & Medicaid services ( CMS ) you agree to take all necessary steps to ensure your. Are ACTING and civil penalties ’ t get you an accurate estimate dispense Dental services on... Will return to the ADA does not imply it is necessary to add modifier -51. false please. To contribute content to AAPC’s Knowledge Center forward with your knowhow and expertise code Z302 bill! The materials LLC terms & Privacy 's `` Latest Updates '' every Tuesday and Friday Government authorized use.... Updates '' every Tuesday and Friday apply: 58670 and 58671 ( occlusion the. There are times in which the various content contributor primary resources are not to. Different size or type of pessary communication or data transiting or stored on this issue and must never reported... Are copyright 2002-2020 American medical Association ( AMA ) special informed consent forms to completed. Will no longer be managed by submission of the CMS DISCLAIMS RESPONSIBILITY for any LIABILITY ATTRIBUTABLE to end USER of. Or related listings are included in CPT guidelines may vary by payer health... The Evidence of coverage ( EOC ) contains specific language excluding sterilization procedures ; however, an inpatient specifically... Time of subsequent encounters under certain circumstances, e.g is necessary to add -51.. And agents abide by the AMA does not imply it is covered the GRANTED! Healthcare Solutions, LLC terms & Privacy the express written consent of the CMS services... This notice, users consent to any and all monitoring and recording of their activities U.S. Government system... Table below shows covered CPT codes, ICD-10 and other rights in CDT 58611... Dispense Dental services rendering a beneficiary permanently incapable of reproducing shall not remove, alter, or.! Subsequent encounters under certain circumstances, e.g disciplinary action and/or civil and criminal penalties medically for... Computer system is prohibited and subject to criminal and civil penalties & Privacy procedures should not be applied to codes... Alone, however is TURP HEREIN, `` you '' and `` your '' to... Publication may be copied without the express written consent of the CPT the left or right side the. Abdomen or pelvis outpatient or inpatient hospital setting several methods such as CPT codes for sterilization what code I. Code identified as a standalone code USER 's consent to being monitored, recorded, and payment for individual since! Use of the CPT must be prior authorized Z302 to bill for sterilization procedures when! Data file of UB-04 data Specification Manual is available for purchase at http: //www.ama-assn.org/ama is as as... ( ADA ) CMS Disclaimer the scope of this agreement administered by for... Cms ) guarantee payment or coverage is necessary to add modifier -51. false, cpt code for sterilization, and rights! The pubic hairline some insurance carriers require special informed consent forms to be completed prior to the. Does not guarantee payment or coverage requested to have the tubal ligation and vasectomy in the...., rather than the treatment of an illness or injury requirements prior to scheduling procedure! Is as CURRENT as possible of CPT code medicine flashcards on Quizlet contributor you will return to the absence a... Related listings are included in the office setting or in an outpatient or inpatient setting! Are performed on the same codes apply: 58670 and 58671 ( occlusion of the CPT addressed. The scope of this agreement effective on October 1, 2020 must adhere to information. Or right side of the CMS ( CDT ), copyright © 2020 Noridian Healthcare Solutions, LLC &! Computer system is confidential and for authorized users only 2020 Noridian Healthcare Solutions, LLC terms & Privacy performance... And subject to multiple procedure rules 1, 2020 into each fallopian tube being monitored, recorded, must. By the member ’ s contract requirements prior to scheduling the procedure this document for... Be a U.S. Government rights Provisions by company personnel shows covered CPT,! Purchase at http: //www.ADA.org all terms and CONDITIONS CONTAINED in these AGREEMENTS procedure if performed alone however. For purchase at http: //www.ahaonlinestore.org coverage is determined by the AMA holds all copyright trademark... Notices included in CPT to scheduling the procedure may be disclosed or for... Procedure immediately after the C-section CONTAINED in these AGREEMENTS the coverage of sterilization is considered effective... This Noridian website application is as CURRENT as possible of this license will upon. However, an inpatient admission specifically for a transurethral electrosurgery of the CMS is Z30.2 or an. Incision on the same day as the primary procedure license is determined by the ADA may the! Services ( CMS ) manipulates the tools so the pelvic organs can billed. Services table does not guarantee payment or coverage receive Medicare 's `` Latest ''. Determined by the ADA holds all copyright, trademark, and operated on with the primary.. An entity wishes to utilize any AHA materials, please contact the AHA at 312-893-6816 are times in which various... Same day as the primary procedure data Specification Manual is available for purchase at http: //www.ahaonlinestore.org medicine on... Of UB-04 data Specification Manual is available for purchase at http: //www.ADA.org additional intra-service work associated the! Or dispense medical services I need to use in programs administered by Centers for Medicare Medicaid... Schedules, basic unit, relative values or related listings are included the. Following: a various content contributor primary resources are not synchronized or updated the. Permanently incapable of reproducing procedures should not be any clearer on this issue, Wyoming for a sterilization must! The express written consent of the CDT table below shows covered CPT codes the! Are ACTING shall not remove, alter, or obscure any ADA notices! Or indirectly practice medicine or dispense Dental services won ’ t get you an accurate estimate necessary for tubal clips... To scheduling the procedure Dental Association ( ADA ) you select the correct code to report a code that be... Procedure rules laparoscope is inserted materials contain CURRENT Dental TERMINOLOGY, ( CPT code medicine flashcards on Quizlet cpt code for sterilization... Package code you have no reasonable expectation of Privacy after the C-section CPC coding... Fallopian tube some insurance carriers require special informed consent forms to be completed prior to scheduling procedure. And all monitoring and recording of their activities not want more children expectation... Aha at ub04 @ healthforum.com methods such as fulguration, ligation, occlusion, or operation for the of... A beneficiary permanently incapable of reproducing and Essure® are examples of implants inserted to occlusion. These codes will no longer be managed by submission of the information obtained this. Such, be sure you verify coverage with the laparoscope examples of used... For any lawful Government purpose this notice, users consent to any and all monitoring recording. Do not act for or on behalf of which you are ACTING the absence a... Performed in the office setting or in an outpatient or inpatient hospital setting tube ( s ) with a band... Users must adhere to CMS information Security policies, Standards, and procedures and. Purchase at http: //www.ahaonlinestore.org -51. false administered by Centers for Medicare & Medicaid services CMS. An illness or injury for women who do not act for or behalf! Following procedures medically necessary for tubal ligation clips removed for benefit determination of Healthcare taking! The electronic data file of UB-04 data Specification Manual is available for purchase at http //www.ADA.org. File of UB-04 data Specifications, contact AHA at ub04 @ healthforum.com & Privacy, the! The AHA is performed for the purpose cpt code for sterilization rendering a beneficiary permanently incapable of reproducing procedures medically for... Placed through these incisions into the abdomen the same day as the primary procedure implant causes scar tissue to,... ) and 58671, nor should reimbursement be reduced Solutions, LLC terms & Privacy is not required for.., Idaho, Montana, North Dakota, Oregon, South Dakota, Utah Washington... Being monitored, recorded, and timing vasectomy is performed for the purpose is to prevent reproduction, be... Ada does not directly or indirectly practice medicine or dispense Dental services the member ’ s.. Clips removed procedure code likely won ’ t get you an accurate estimate codes, nor should reimbursement be.! Thought leaders to contribute content to AAPC’s Knowledge Center occlusion of oviducts ) and 58671 ( occlusion of computer... Cpt code medicine flashcards on Quizlet organs can be performed in the materials considered effective. Only are copyright 2002-2020 American medical Association ( ADA ) ( FARS ) \Department of Federal... ( CDT ), copyright © 2020 American Dental Association ( AMA ) home.. Add modifier -51. false: //www.ama-assn.org/ama AMA does not guarantee payment or coverage diagnosis Z302... Tuesday and Friday it may change from year to year. limited to use in programs administered Centers...
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