How To Use CPT Code 59120

CPT 59120 describes the surgical treatment of ectopic pregnancy, specifically the removal of the fallopian tube or ovary, or both, using either an abdominal or vaginal approach. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 59120?

CPT 59120 can be used to describe the surgical treatment of ectopic pregnancy, where the provider removes the fallopian tube or ovary, or both. This procedure is necessary when there is a large fetus embedded around the ovary or in the fallopian tube, or when an ectopic pregnancy has already ruptured the fallopian tube. The removal can be performed abdominally or vaginally, depending on the specific circumstances of the case.

2. Official Description

The official description of CPT code 59120 is: ‘Surgical treatment of ectopic pregnancy; tubal or ovarian, requiring salpingectomy and/or oophorectomy, abdominal or vaginal approach.’

3. Procedure

1. In an abdominal approach, the provider administers a general anesthetic and makes an incision in the lower abdomen. They explore the pelvic cavity to locate the ectopic pregnancy and any bleeding. Any products of conception, blood clots, or free blood present are aspirated. The damaged fallopian tube or ovary, or both, are then removed. The entrance to the body of the uterus is sutured if the fallopian tube is removed, or the infundibulopelvic ligaments are incised to release the ovary if it is being removed. The pelvic cavity is washed with saline, checked for bleeding, and the abdomen is closed with sutures.
2. In a vaginal approach, the provider administers a general anesthetic and places the patient in the dorsal lithotomy position. A weighted speculum is placed on the posterior vaginal wall, and the posterior lip of the cervix is grasped with a tenaculum. The provider makes a vertical incision in the posterior vaginal wall into the pouch of Douglas and drains any blood or clots present. The incision is extended on both sides, and an abdominal pack is placed to push the bowel out of the way. Forceps are used to grasp the ovarian ligament, allowing the provider to expose the fallopian tube or ovary. The damaged tissue is excised, and any products of conception are removed if the ectopic pregnancy has ruptured. The entrance to the body of the uterus is sutured, and the incision in the vaginal wall is closed.

4. Qualifying circumstances

CPT 59120 is performed when there is an ectopic pregnancy that requires the removal of the fallopian tube or ovary, or both. The decision to perform this procedure is based on the specific circumstances of the case, such as the location of the ectopic pregnancy and whether it has already caused damage or rupture. The provider must determine that the removal of the fallopian tube or ovary, or both, is necessary for the treatment of the ectopic pregnancy.

5. When to use CPT code 59120

CPT code 59120 should be used when the surgical treatment of ectopic pregnancy involves the removal of the fallopian tube or ovary, or both, using either an abdominal or vaginal approach. It is important to accurately document the specific procedure performed and the approach used in the medical record to support the use of this code.

6. Documentation requirements

To support a claim for CPT 59120, the provider must document the following information:

• Diagnosis of ectopic pregnancy
• Reason for the surgical treatment and the need for removal of the fallopian tube or ovary, or both
• Approach used (abdominal or vaginal)
• Details of the procedure, including any additional steps taken or complications encountered
• Any products of conception, blood clots, or free blood aspirated or removed
• Confirmation of closure of the entrance to the body of the uterus or closure of the incision in the vaginal wall
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 59120, ensure that the surgical treatment of ectopic pregnancy involves the removal of the fallopian tube or ovary, or both, using either an abdominal or vaginal approach. It is important to accurately document the approach used and any additional steps taken during the procedure. CPT code 59120 should not be reported with a modifier 50 for bilateral procedure, as Medicare and payers who follow Medicare rules consider it a bilateral code.

8. Historical information

CPT 59120 was added to the Current Procedural Terminology system on January 1, 1990. The code has not undergone any updates since its addition. In 2017, it was added to the Inpatient Only (IPO) list for Medicare.

9. Examples

1. A provider performs CPT 59120 to remove a fallopian tube with an ectopic pregnancy that has already ruptured.
2. In a different case, a provider uses CPT 59120 to remove an ovary and fallopian tube due to a large fetus embedded around the ovary.
3. Another provider performs CPT 59120 abdominally to remove a fallopian tube with an ectopic pregnancy that has not yet ruptured.
4. In a vaginal approach, a provider uses CPT 59120 to remove an ovary and fallopian tube in a patient with an ectopic pregnancy.
5. A provider performs CPT 59120 vaginally to remove a fallopian tube with an ectopic pregnancy that has already ruptured.