The healthcare system relies on the Current Procedural Terminology (CPT) system to communicate medical services. CPT codes are numerical identifiers that describe specific procedures and services performed by healthcare providers. This article explores CPT code 58661, which is used in gynecological surgery for minimally invasive procedures.
The Official Description and Scope
CPT code 58661 is officially titled “Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy).” Adnexal structures refer to the ovaries and fallopian tubes. This code describes the laparoscopic removal of one or both of these organs, including salpingectomy (fallopian tube removal) or oophorectomy (ovary removal), utilizing a minimally invasive approach.
The code’s application extends to the treatment of complex conditions, including the removal of an ovary or tube due to a large ovarian mass, sterilization, or ectopic pregnancy management. Though the code does not specifically name myomectomy or endometriosis treatment, it is the appropriate code when the severity of these conditions requires the excision of an adjacent fallopian tube or ovary to achieve treatment goals. The use of 58661 represents a definitive, surgical intervention involving the excision of a reproductive structure.
Surgical Approach and Clinical Indications
The “Laparoscopy, surgical” component of CPT 58661 indicates the procedure is performed using a minimally invasive technique. The surgeon makes several small incisions, typically less than one centimeter, in the patient’s abdomen. A laparoscope, a thin tube equipped with a high-definition camera, is inserted through one incision to provide a magnified view of the pelvic organs. Carbon dioxide gas is introduced into the abdominal cavity to create a working space, improving visibility and access.
The remaining small incisions allow for the insertion of surgical instruments used to dissect and remove the targeted adnexal structures. This minimally invasive approach is preferred over traditional open surgery (laparotomy) because it is associated with less post-operative pain, smaller scars, and a faster recovery time. In clinical practice, the conditions that most commonly indicate the use of 58661 are those affecting the ovaries and fallopian tubes.
One key indication is the presence of an ovarian mass or cyst, particularly if it is large, persistent, or raises suspicion for malignancy, necessitating the complete removal of the ovary (oophorectomy). Another common use is for the management of ectopic pregnancy, where the fallopian tube housing the pregnancy must be removed (salpingectomy) to prevent rupture. Patients with a high genetic risk for ovarian cancer, such as those with BRCA1 or BRCA2 gene mutations, may undergo a prophylactic bilateral salpingo-oophorectomy, which is coded with 58661. The removal of a fallopian tube for permanent sterilization is also appropriately reported with this code.
Key Billing and Documentation Requirements
Accurate billing for CPT 58661 requires documentation to demonstrate the medical necessity of the surgical intervention. The operative report must detail the laparoscopic approach, confirm the structures removed (ovary, tube, or both), and specify whether the procedure was unilateral or bilateral. Pre-operative documentation, such as imaging studies, must justify the decision to remove the adnexal structure rather than perform a less invasive procedure.
CPT 58661 is considered a unilateral code, describing the removal of structures on one side of the body. If the procedure is performed on both sides—such as a bilateral salpingectomy for sterilization—the code must be reported with the modifier -50, which signifies a bilateral procedure performed during the same operative session.
The use of other modifiers is common with this code. Modifier -59 may be necessary if 58661 is performed alongside another distinct, separately identifiable procedure. If the surgery involves unusual procedural services, such as increased time or complexity due to severe adhesions or pathology, modifier -22 may be appended, requiring additional documentation submission to the payer for review. Finally, this surgical code must be distinguished from diagnostic laparoscopy (CPT 49320), which involves only exploration and visualization; surgical laparoscopy inherently includes the diagnostic component and should not be billed separately.