58720

Salpingo-oophorectomy, complete or partial, unilateral or bilateral (separate procedure)

CPT code 58720 describes a surgical procedure performed via an open abdominal approach (laparotomy) for the removal of one or both fallopian tubes (salpingectomy) and one or both ovaries (oophorectomy). The procedure can be partial or complete. Clinically, this surgery is often performed to treat various gynecological pathologies such as benign or malignant ovarian tumors, chronic pelvic inflammatory disease, tubo-ovarian abscesses, endometriosis involving the adnexa, or ovarian torsion. It is also frequently utilized as a prophylactic risk-reducing measure for patients with high-risk genetic mutations, such as BRCA1 or BRCA2, which significantly increase the lifetime risk of ovarian and fallopian tube cancers. During the procedure, the surgeon makes an abdominal incision, such as a Pfannenstiel or vertical midline incision, to gain access to the pelvic cavity. The adnexal structures are carefully inspected and isolated from surrounding pelvic tissues and adhesions. The major vascular supplies, specifically the ovarian vessels within the infundibulopelvic ligament, are clamped, ligated, and transected. Similarly, the utero-ovarian ligament and the fallopian tube's attachment to the uterine cornua are secured and cut. Because the code is designated as a 'separate procedure' in the CPT manual, it should not be reported when it is an integral component of a more extensive procedure, such as a total abdominal hysterectomy, unless the salpingo-oophorectomy is performed for a distinct clinical indication or on the contralateral side in a manner not inherent to the primary procedure.

Clinical Indications

  • Ovarian neoplasm (benign or malignant)
  • Fallopian tube neoplasm
  • Tubo-ovarian abscess (TOA) unresponsive to medical management
  • Hydrosalpinx or chronic salpingitis
  • Ovarian torsion resulting in ischemia
  • Endometriosis of the ovary (endometrioma)
  • Prophylactic risk reduction for patients with BRCA1/BRCA2 or Lynch syndrome
  • Chronic pelvic pain associated with adnexal pathology

Procedure Steps

  1. Induction of general anesthesia and placement of the patient in the supine or Trendelenburg position.
  2. Skin preparation and sterile draping of the abdomen.
  3. Performance of a laparotomy via Pfannenstiel or midline vertical incision to access the peritoneal cavity.
  4. Exploration of the pelvis and upper abdomen for pathology, followed by lysis of any limiting adhesions.
  5. Identification and isolation of the fallopian tube and ovary.
  6. Clamping, ligation, and transection of the infundibulopelvic ligament to secure the ovarian artery and vein.
  7. Clamping, ligation, and transection of the utero-ovarian ligament and the proximal end of the fallopian tube.
  8. Removal of the adnexal specimens (unilateral or bilateral) for histopathological analysis.
  9. Verification of hemostasis at the surgical sites.
  10. Irrigation of the pelvic cavity and closure of the abdominal wall layers (fascia, subcutaneous tissue, and skin).

Coding Guidelines

  • CPT 58720 is a 'separate procedure.' This means it should not be reported if it is an integral component of a larger procedure (e.g., a hysterectomy) performed at the same session and in the same region.
  • The code descriptor states 'unilateral or bilateral.' Therefore, modifier 50 (bilateral procedure) should not be used. The reimbursement remains the same whether one or both sides are removed.
  • If the procedure is performed laparoscopically, use CPT 58661 instead of 58720.
  • If the salpingo-oophorectomy is performed for an ectopic pregnancy, refer to codes 59120 (tubal) or 59121 (oophorectomy).
  • Do not report 58720 in conjunction with 58150 (Total abdominal hysterectomy) unless it is a distinct, non-bundled encounter.

Associated ICD-10 Codes