Dilation of the Fallopian tubes is really more of a cleansing of the tubes than a true dilation. The tubes are very small and thin-walled. The most common cause for blockage is from an infection that results in strictures and fibrosis of the tube(s). A hydrosalpinx is the medical name for a fallopian tube that has become filled with fluid due to injury or infection. Separate CPT code 58345, 58356, 58615 & 58999, are used for examination of hydrosalpinx.
There are several ways to diagnose a hydrosalpinx. These methods include the ultrasound, hysterosalpingogram, laparoscopy etc. Generally hysterosalpingography is performed. Tube dilation is performed under fluoroscopic guidance via a vaginal speculum and transcervical occlusion guidance catheter. This allows microwire and/or microcatheter placement under fluoroscopic guidance into the tube. The simple act of passing the wire/catheter usually results in tubal patency. Transcatheter occlusion of the fallopian tubes with microinsert devices can also be performed using similar techniques.
Also, we will learn about Endometrial cyroablation, a minimally invasive procedure used for abnormal uterine bleeding. It reduces or eliminate excessive menstrual periods.
Description of Procedure code 58345, 58356, 58615/58999
58345 – Transcervical introduction of fallopian tube catheter for diagnosis and/or re-establishing patency (any method), with or without hysterosalpingography
58615/58999 – Occlusion of fallopian tube(s) by device (eg, band, clip, Falope ring) vaginal or suprapubic approach
58356 – Endometrial cryoablation with ultrasonic guidance, including endometrial curettage, when performed
(For radiological supervision and interpretation use 74742)
74742 – Transcervical Catheterization, Fallopian Tube, Radiological S&I
0404T – Transcervical uterine fibroid(s) ablation with ultrasound guidance, radiofrequency
Read also: Coding tips for Induced abortion for Medical coders
Coding guidelines for 58345, 58356, 58615 & 58999
Fallopian tube dilation exam, CPT code 58345 is a unilateral exam, if performed bilaterally do append 50 modifier to the CPT code.
Do not code hysterosalpingram 58340 along with 58345, it is included in the procedure code 58345.
Do not use ultrasound guidance code along with endometrial ablation, CPT code 58356, exam, it is bundled in the cryoablation procedure code.
Do use CPT code 58615 or 58999 for unilateral or bilateral fallopian tube embolization with coils (to cause occlusion).
Do use CPT code 74742 along with with CPT code 58615 or 58999, for the image guidance for catheterization of the fallopian tubes.
For laparoscopic approach for occlusion of fallopian tube use CPT code 58671.
Do use code 0404T when uterine fibroids are treated with transcervical RF ablation technique using ultrasound guidance.
