CPT® Code 0567T

Code Deleted. See 58999.

Official Description

Permanent fallopian tube occlusion with degradable biopolymer implant, transcervical approach, including transvaginal ultrasound

Common Language Description

The procedure described by CPT® Code 0567T involves the permanent occlusion of the fallopian tubes in female patients, utilizing a degradable biopolymer implant. This method is performed through a transcervical approach, which means that the procedure is conducted via the cervix, allowing for direct access to the uterine cavity. The primary goal of this procedure is sterilization, achieved by blocking the fallopian tubes to prevent the passage of eggs from the ovaries to the uterus. The biopolymer implant is designed to trigger a natural wound-healing response in the body, leading to the formation of scar tissue that permanently occludes the fallopian tubes. To initiate the procedure, a transvaginal ultrasound is performed using a vaginal probe, which provides visualization of the uterus and the fallopian tubes' location. This imaging is crucial for accurately placing the occlusion devices. Following the ultrasound, a flexible catheter is introduced through the cervix into the uterine cavity, allowing for the precise delivery of the biopolymer into the fallopian tubes. The biopolymer is injected in a liquid form, and as it degrades over time, it facilitates the bonding of the fallopian tissue, ultimately leading to closure. A follow-up ultrasound is typically conducted three months post-procedure to confirm the successful occlusion of the fallopian tubes, ensuring the effectiveness of the sterilization process.

1. Indications

The procedure described by CPT® Code 0567T is indicated for female patients seeking permanent sterilization. The specific indications for this procedure include:

Permanent Sterilization The primary indication for this procedure is to achieve permanent contraception by occluding the fallopian tubes, thereby preventing fertilization.

2. Procedure

The procedure for permanent fallopian tube occlusion with a degradable biopolymer implant involves several detailed steps to ensure successful implementation. The steps are as follows:

Step 1: Transvaginal Ultrasound Initially, a transvaginal ultrasound is performed using a vaginal probe. This imaging technique allows the physician to visualize the uterus and the precise location of the fallopian tubes, which is essential for the accurate placement of the occlusion devices.
Step 2: Preparation After the ultrasound, the vaginal probe is removed, and a speculum is inserted to provide access to the cervix. The cervical os is then cleansed to maintain a sterile environment during the procedure.
Step 3: Catheter Insertion A small-diameter flexible catheter is carefully placed through the cervix and into the uterine cavity. This catheter serves as the delivery mechanism for the biopolymer implant.
Step 4: Biopolymer Injection The vaginal probe is reinserted to visualize the catheter's advancement into the proximal tubal ostium. Once in position, the physician injects approximately 1.2 mL of a liquid biopolymer through the catheter into the fallopian tube. This step is crucial for initiating the occlusion process.
Step 5: Repeat for Opposite Tube The procedure is then repeated on the opposite tubal ostium to ensure bilateral occlusion of the fallopian tubes, thereby enhancing the effectiveness of the sterilization.

3. Post-Procedure

After the completion of the procedure, patients are typically monitored for any immediate complications. It is important to schedule a follow-up ultrasound approximately three months post-procedure to confirm the successful closure of the fallopian tubes. This follow-up is essential to ensure that the biopolymer has effectively caused the fallopian tissue to bond and that permanent occlusion has been achieved. Patients may be advised on post-procedure care, including any activity restrictions and signs of potential complications to watch for during the recovery period.

Short Descr	PERM FLP TUBE OCCLS W/IMPLT
Medium Descr	PERM FLP TUB OCCLS W/IMPLANT TRANSCRV APPROACH
Long Descr	Permanent fallopian tube occlusion with degradable biopolymer implant, transcervical approach, including transvaginal ultrasound
Status Code	Carriers Price the Code
Global Days	YYY - Carrier Determines Whether Global Concept Applies
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Non-Covered Service, not paid under OPPS
Berenson-Eggers TOS (BETOS)	none
MUE	Not applicable/unspecified.