Bilateral Salpingectomy / Tubal Ligation

CPT 58661
Approach Minimally Invasive
Add-on / Variant CPTs
  • 58670 — Laparoscopy with fulguration of oviducts
  • 58600 — Ligation or transection of fallopian tube(s), open
Preoperative Diagnosis:

Desired permanent sterilization [/ risk reduction for high-grade serous carcinoma (BRCA1/2 carrier)]

Postoperative Diagnosis:

Same

Procedure Performed:

Laparoscopic bilateral salpingectomy [/ bilateral partial salpingectomy / bilateral tubal ligation with Filshie clips]

Attending Surgeon:

[Attending name], MD/DO

First Assistant:

[Nurse/tech name]

Anesthesia:

General endotracheal [/ spinal]

Indications:

The patient is a [age]-year-old [female] seeking permanent sterilization [/ BRCA1/2 carrier desiring salpingectomy for ovarian cancer risk reduction]. Bilateral salpingectomy was recommended [over tubal ligation] given its superior efficacy and [potential for ovarian cancer risk reduction via removal of the fimbrial epithelium]. The irreversibility of the procedure was discussed. Cooling-off period has elapsed. The risks, benefits, and alternatives were discussed and informed consent was obtained.

Findings:

The bilateral fallopian tubes were [normal in appearance / with [hydrosalpinx / paratubal cysts]]. The ovaries were [normal / with small follicular cysts]. The uterus was [normal]. Both tubes were completely excised to the cornual margin.

Description of Procedure:

The patient was positioned in the dorsal lithotomy position with Trendelenburg. A [10-mm] umbilical port was placed via [Veress needle / optical trocar / Hasson open technique]. CO₂ insufflation to [15 mmHg]. Two [5-mm] ports were placed in the lower quadrants under direct vision.

The right fallopian tube was grasped at the fimbrial end and elevated. [SALPINGECTOMY: The mesosalpinx was desiccated with [bipolar / harmonic shears] along the entire length of the tube. The proximal tube was coagulated and divided at the cornual junction, ensuring complete removal of the intramural tubal segment. The right fallopian tube was excised in its entirety from fimbria to cornua and placed in a retrieval bag.]

[FILSHIE CLIPS / TUBAL LIGATION: The tube was identified in the midportion. A Filshie clip was applied to the isthmic portion of the tube [1–2 cm from the cornua] with the applicator, crushing the tube completely. A second clip was applied [3 mm] distal to the first. This was repeated on the left.]

The procedure was repeated on the left side in identical fashion. Both tubes were confirmed completely removed [/ occluded].

The specimens were extracted through the umbilical port. The pelvis was irrigated. Hemostasis was confirmed. Port sites were closed with [3-0 Monocryl].

Complications:

None

Specimens:

Right fallopian tube, sent to pathology
Left fallopian tube, sent to pathology

Estimated Blood Loss:

Minimal

Drains:

None

Disposition:

The patient was taken to the PACU in stable condition. Same-day discharge was anticipated. The patient was counseled that sterilization is immediately effective following salpingectomy.

Epic SmartPhrase Version 
PREOPERATIVE DIAGNOSIS: Desired permanent sterilization [/ BRCA risk reduction]
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE PERFORMED: Laparoscopic bilateral salpingectomy
ATTENDING: ***, MD/DO
ASSISTANT: ***
ANESTHESIA: General

INDICATIONS: .PTAGE-year-old .PTSEX, permanent sterilization [/ BRCA *** risk reduction]. Irreversibility discussed. Consent obtained.

FINDINGS: Bilateral tubes normal. Ovaries normal. Both tubes completely excised cornua to fimbria.

PROCEDURE:
Lithotomy, Trendelenburg. Umbilical port [Veress needle / optical trocar / Hasson]. CO2 15 mmHg. *** ports. Right tube elevated at fimbriae. Mesosalpinx desiccated bipolar/harmonic. Proximal tube coagulated/divided at cornual junction — complete excision. Specimen in bag. Repeated left. Both tubes removed cornua to fimbria. Specimens extracted umbilical port. Irrigated, hemostatic. Ports closed.

EBL: Minimal
SPECIMENS: Bilateral tubes to pathology separately
COMPLICATIONS: None
DISPOSITION: Same-day DC. Immediately effective sterilization.

Signed: .ME, .MYDEGREE
.TODAY
Variants

Postpartum Tubal Ligation (Pomeroy / Modified Pomeroy)

Postpartum tubal ligation was performed within [48 hours] of delivery through a [minilaparotomy] via a [3]-cm infraumbilical incision while the uterine fundus was still elevated. The right tube was identified and a knuckle of [2–3 cm] of the isthmic portion was elevated with a Babcock clamp. A [0-chromic] suture was ligated around the base of the knuckle and the knuckle was excised. The same was performed on the left. Specimens were sent to pathology to confirm fallopian tube tissue was excised (Pomeroy technique). The incision was closed in layers.

Charting Tips
  • Document complete salpingectomy to the cornual margin. Incomplete salpingectomy leaving the intramural/interstitial portion of the tube is associated with higher ectopic pregnancy risk and negates the ovarian cancer risk reduction benefit. Document 'excised from fimbria to cornual junction, ensuring complete removal.'
  • Document cooling-off period and informed consent for irreversibility. Sterilization must be performed with documented counseling on permanence and failure rates. Document when consent was obtained (not at the time of procedure for elective sterilization) and that the patient was counseled on the irreversibility.
  • Document bilateral tubal specimens sent to pathology. Confirmatory pathology ensures fallopian tube tissue was actually excised (and not round ligament or other structure). Document 'bilateral fallopian tubes sent to pathology to confirm complete excision.'
Billing Tips
  • Bill 58600 for division of fallopian tube, open approach (5.76 wRVU, 90-day global). Bill 58605 for postpartum tubal ligation within 30 days of delivery (5.15 wRVU, 90-day global).
  • Bill 58670 for laparoscopic tubal cauterization/coagulation (5.76 wRVU, 90-day global). Bill 58671 for laparoscopic tubal occlusion with device (Filshie clip, Falope ring, 5.76 wRVU, 90-day global).
  • Postpartum tubal ligation (58605) performed at the time of cesarean delivery is separately billable. Bill 59514 (C-section delivery) plus 58605 with modifier -51. Document that the procedure was performed as a separate, distinct component.
  • 90-day global period: routine follow-up and contraceptive counseling are bundled. Ectopic pregnancy occurring after tubal ligation is a new medical event and is fully billable.
  • Hysteroscopic tubal occlusion (Essure, now removed from market) used 58565. If reversal of sterilization is requested, bill 58750 (laparoscopic) or 58752 (open tubal anastomosis). These are distinct procedures with their own codes.