How To Use CPT Code 58720
CPT 58720 refers to the surgical procedure known as salpingo-oophorectomy, which involves the complete or partial removal of one or both fallopian tubes and ovaries. This procedure is typically performed to address various medical conditions, including ovarian cysts, tumors, or ectopic pregnancies. The surgery is conducted through an abdominal incision, allowing the provider to access the reproductive organs directly. The decision to perform a unilateral or bilateral procedure depends on the patient’s specific clinical situation and the underlying reason for the surgery.
1. What is CPT code 58720?
CPT code 58720 represents the surgical procedure of salpingo-oophorectomy, which can be either complete or partial and can be performed unilaterally (on one side) or bilaterally (on both sides). This procedure is crucial in gynecological surgery, particularly for patients with conditions affecting the ovaries and fallopian tubes. The primary purpose of this surgery is to remove diseased or damaged reproductive organs, which may be causing pain, dysfunction, or other health issues. The clinical relevance of this procedure lies in its ability to alleviate symptoms and prevent further complications associated with various gynecological disorders.
2. Qualifying Circumstances
This CPT code can be utilized in specific clinical scenarios where the removal of the fallopian tubes and ovaries is indicated. Such circumstances may include the presence of ovarian tumors, severe endometriosis, or recurrent ovarian cysts. Additionally, it may be appropriate in cases of ectopic pregnancy, where the embryo implants outside the uterus, often in a fallopian tube. However, it is important to note that this procedure should not be performed in patients who are pregnant or have active infections in the pelvic region. The decision to proceed with a salpingo-oophorectomy must be based on a thorough evaluation of the patient’s medical history and current health status.
3. When To Use CPT 58720
CPT code 58720 is used when a provider performs a salpingo-oophorectomy as part of a surgical intervention for the aforementioned conditions. It is essential to document the clinical rationale for the procedure, including any imaging studies or diagnostic tests that support the need for surgery. This code may be used in conjunction with other surgical codes if additional procedures are performed during the same surgical session. However, it is important to avoid using this code alongside codes that represent similar procedures, such as salpingectomy, to prevent billing discrepancies.
4. Official Description of CPT 58720
Official Descriptor: Salpingo-oophorectomy, complete or partial, unilateral or bilateral (separate procedure).
5. Clinical Application
The clinical application of CPT 58720 is primarily in the treatment of conditions affecting the female reproductive system. This procedure is often indicated for patients experiencing significant pain or complications due to ovarian or fallopian tube disorders. By removing these organs, the provider aims to alleviate symptoms, prevent the progression of disease, and improve the patient’s overall quality of life. The importance of this procedure cannot be overstated, as it plays a vital role in managing gynecological health and addressing serious medical concerns.
5.1 Provider Responsibilities
During the salpingo-oophorectomy procedure, the provider has several critical responsibilities. Initially, the provider positions the patient in the supine position and administers general anesthesia to ensure the patient is comfortable and pain-free throughout the surgery. The provider then makes an incision in the lower abdomen, just above the pubic bone, and carefully incises the peritoneum to explore the abdominal cavity. Following this, the provider creates another incision to expose the broad ligament, dissects the fallopian tube away from the ligament, and removes it from the abdomen. The provider then incises the infundibulopelvic ligament to free the ovary and removes it as well. If a bilateral procedure is indicated, the provider repeats these steps for the other side. After ensuring hemostasis, the provider closes the abdomen and places a Foley catheter to facilitate drainage.
5.2 Unique Challenges
Salpingo-oophorectomy presents several unique challenges that providers must navigate during the procedure. One significant challenge is managing bleeding, as the reproductive organs are highly vascularized. The provider must be skilled in identifying and controlling any bleeding vessels to achieve hemostasis effectively. Additionally, the procedure requires careful dissection to avoid damaging surrounding structures, such as the bladder or intestines. Providers must also consider the patient’s overall health and any comorbidities that may complicate the surgery or recovery process.
5.3 Pre-Procedure Preparations
Before performing a salpingo-oophorectomy, the provider must conduct thorough pre-procedure evaluations. This includes obtaining a detailed medical history, performing a physical examination, and ordering imaging studies, such as ultrasounds or CT scans, to assess the condition of the ovaries and fallopian tubes. Laboratory tests may also be necessary to evaluate the patient’s overall health and ensure they are fit for surgery. Additionally, the provider must discuss the procedure with the patient, including potential risks and benefits, to obtain informed consent.
5.4 Post-Procedure Considerations
After the salpingo-oophorectomy, the patient requires careful monitoring and follow-up care. The provider must assess the patient for any signs of complications, such as infection or excessive bleeding. Pain management is also a critical aspect of post-operative care, and the provider may prescribe medications to help alleviate discomfort. The Foley catheter placed during the procedure will typically remain in place for a short period to promote drainage. Follow-up appointments are essential to monitor the patient’s recovery and address any concerns that may arise.
6. Relevant Terminology
Broad ligament: A large fold of peritoneum that supports the uterus and encases the ovaries and fallopian tubes.
Fallopian tubes: Two slender tubes that connect the ovaries to the uterus, facilitating the passage of eggs.
Foley catheter: A catheter with an inflatable balloon tip used to drain urine from the bladder.
Hemostasis: The process of stopping bleeding or blood flow.
Infundibulopelvic ligament: Ligaments that attach the ovaries to the pelvic wall, which must be cut to remove the ovaries.
Ovaries: Female reproductive organs responsible for producing eggs and hormones.
Peritoneum: The membrane lining the abdominal cavity.
Salpingectomy: The surgical removal of a fallopian tube.
Salpingo oophorectomy: The surgical removal of both a fallopian tube and an ovary.
Supine position: A position where the patient lies flat on their back with legs extended.
7. Clinical Examples
1. A 35-year-old woman presents with recurrent ovarian cysts that have not responded to conservative treatment, leading to significant pelvic pain.
2. A patient diagnosed with stage I ovarian cancer undergoes a salpingo-oophorectomy as part of her treatment plan.
3. A 28-year-old woman experiences an ectopic pregnancy in her right fallopian tube and requires surgical intervention to remove the affected tube and ovary.
4. A patient with severe endometriosis undergoes a bilateral salpingo-oophorectomy to alleviate chronic pain and prevent further complications.
5. A 40-year-old woman with a family history of ovarian cancer opts for a prophylactic salpingo-oophorectomy to reduce her risk of developing the disease.
6. A patient with a large benign ovarian tumor is scheduled for a unilateral salpingo-oophorectomy to remove the tumor and preserve the other ovary.
7. A 50-year-old woman undergoing a hysterectomy for fibroids also has a salpingo-oophorectomy performed due to the presence of cysts on her ovaries.
8. A patient with pelvic inflammatory disease requires a salpingo-oophorectomy to remove infected fallopian tubes and ovaries.
9. A 30-year-old woman with unexplained infertility is found to have blocked fallopian tubes and undergoes a bilateral salpingo-oophorectomy.
10. A patient with a history of ovarian torsion presents for surgery to remove the affected ovary and fallopian tube to prevent recurrence.
