Bilateral Salpingectomy / Tubal Ligation
5866158670wRVU: 5.76 — Laparoscopy with fulguration of oviducts58600wRVU: 5.76 — Ligation or transection of fallopian tube(s), open
Desired permanent sterilization [/ opportunistic salpingectomy for average-risk ovarian cancer risk reduction at time of planned surgery]
Same
Laparoscopic bilateral salpingectomy [/ bilateral partial salpingectomy / bilateral tubal ligation with Filshie clips]
[Attending name], MD/DO
[Nurse/tech name]
General endotracheal [/ spinal]
The patient is a [age]-year-old [female] seeking permanent sterilization. Bilateral salpingectomy was recommended over tubal ligation given superior efficacy and potential reduction in ovarian cancer risk via removal of the fimbrial epithelium (ACOG Committee Opinion 774, 2019 — applies to average-risk women). Note: BRCA1/2 carriers are NOT candidates for salpingectomy alone as their risk-reduction procedure — ACOG and SGO guidelines recommend risk-reducing bilateral salpingo-oophorectomy (RRBSO) at ages 35–40 (BRCA1) or 40–45 (BRCA2). Salpingectomy alone does not meet the standard of care for hereditary ovarian cancer syndrome. The irreversibility of the procedure was discussed. Cooling-off period has elapsed. Informed consent was obtained.
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.
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 single Filshie clip was applied to the isthmic portion of the tube [1–2 cm from the cornua] with the applicator, crushing the tube completely across its full diameter. One clip per tube is the standard technique per manufacturer instructions (Femcare/CooperSurgical). 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].
None
Right fallopian tube, sent to pathology
Left fallopian tube, sent to pathology
Minimal
None
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 [/ opportunistic salpingectomy for ovarian cancer risk reduction]
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE PERFORMED: Laparoscopic bilateral salpingectomy
ATTENDING: ***, MD/DO
ASSISTANT: ***
ANESTHESIA: General
INDICATIONS: .PTAGE-year-old .PTSEX, permanent sterilization [/ opportunistic salpingectomy, average-risk OC 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
.TODAYVariants
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 plain gut] suture was ligated around the base of the knuckle and the knuckle was excised. Note: the Pomeroy technique requires rapidly absorbable suture (plain gut, not chromic) — rapid absorption causes tubal stump separation, which is the mechanism of the procedure. Chromic catgut's slower absorption impairs this separation step. 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 salpingectomy to the cornual junction. Routine laparoscopic salpingectomy divides the tube at the uterotubal junction externally but does NOT remove the intramural (interstitial) portion embedded in the myometrium — this is standard and acceptable. Cornual resection to remove the intramural segment is not routinely performed and carries bleeding risk. The ovarian cancer risk reduction benefit is derived primarily from fimbrial excision (the site of STIC lesion origin), which is fully achieved by standard salpingectomy regardless of the intramural remnant. Document 'tube excised from fimbria to cornual margin.'
- 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).
- Tubal ligation at the time of cesarean delivery uses CPT 58611 (add-on code, 1.41 wRVU) — NOT 58605. Bill 59514 (C-section) plus +58611 listed separately. Do not append modifier -51 to 58611, as add-on codes are exempt from modifier -51. CPT 58605 is for postpartum tubal ligation after vaginal delivery during the same hospitalization. Using 58605 for a C-section sterilization will result in a denial.
- 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.
General coding reference. Verify with your institution’s billing department before submitting claims.