CPT codes are standardized identifiers used by healthcare providers to describe medical, surgical, and diagnostic services to insurance payers. CPT code 58661 is a specific identifier designated for a common gynecological surgical procedure performed using a minimally invasive technique. This code identifies the removal of female reproductive structures near the uterus, known as adnexa, and understanding it requires knowing the details of the surgery and its administrative context in billing.
The Laparoscopic Procedure
CPT code 58661 specifically describes a “Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy).” Laparoscopy is a form of minimally invasive surgery that avoids the need for a large abdominal incision. The surgeon inserts a thin instrument called a laparoscope, which contains a camera and a light, through a small incision near the navel to view the pelvic organs on a monitor.
The term “adnexal structures” refers to the anatomical parts near the uterus, primarily the ovaries and the fallopian tubes. The procedure involves the partial or complete removal of one or both of these structures. An oophorectomy is the removal of an ovary, and a salpingectomy is the removal of a fallopian tube.
The surgeon makes two to three additional small incisions, typically near the bikini line, to insert specialized surgical instruments. Using these instruments, the surgeon detaches and removes the targeted adnexal structures through one of the small incisions. This minimally invasive approach leads to reduced blood loss, shorter hospital stays, less post-operative pain, and a quicker recovery time compared to traditional open surgery.
Medical Necessity for the Operation
The removal of adnexal structures is performed for various medical conditions affecting the ovaries and fallopian tubes. One common reason is the management of large or complex ovarian masses or cysts that are causing symptoms. Surgery is often needed to remove tissue for definitive diagnosis and treatment, even though most adnexal masses are benign.
The procedure is also indicated for managing ectopic pregnancy, especially when the fertilized egg has implanted in the fallopian tube. Another indication is the prophylactic removal of the tubes or ovaries to reduce cancer risk in patients with genetic predispositions, such as those with BRCA gene mutations. This procedure aims to prevent the development of ovarian or fallopian tube cancer.
The surgery may be necessary to address damage caused by severe pelvic inflammatory disease (PID), which can scar the fallopian tubes. Severe endometriosis that affects the adnexa, creating painful cysts or extensive adhesions, is another reason for removal. The procedure is also used for permanent sterilization, involving the complete removal of the fallopian tubes.
Understanding the Billing Context
CPT code 58661 is used in medical billing to represent the surgical service of laparoscopic adnexal removal. The code description specifies that it applies to the surgical removal of adnexal structures via laparoscopy, including partial or total removal of the ovary or fallopian tube. This specificity ensures correct documentation and appropriate reimbursement from insurance payers.
Since this code describes a procedure that can occur on the left or right side, it is considered a unilateral code. When the surgeon performs the removal on both sides, such as a bilateral salpingectomy, Modifier 50 must be appended to CPT 58661. The application of Modifier 50 indicates that a bilateral procedure was performed, which is required for correct payment.
The code must be distinguished from other related laparoscopic codes to prevent billing errors. CPT 58661 (removal of structures) is distinct from CPT 58660, which represents the laparoscopic lysis, or cutting, of adhesions. It also differs from CPT 58662, which is used for the laparoscopic excision or destruction of lesions, such as an ovarian cystectomy where the ovary is preserved. Lysis of adhesions (58660) is often bundled into the primary procedure and cannot be billed separately alongside 58661.