CPT® Code 58345

Official Description

Transcervical introduction of fallopian tube catheter for diagnosis and/or re-establishing patency (any method), with or without hysterosalpingography

Common Language Description

The CPT® Code 58345 refers to the transcervical introduction of a fallopian tube catheter, a procedure utilized for both diagnostic purposes and the re-establishment of patency in the fallopian tubes. This procedure can be performed using various methods and may or may not include hysterosalpingography, which is an imaging technique used to visualize the inside of the uterus and fallopian tubes. During the procedure, a physician typically begins with a baseline transvaginal ultrasound to assess the reproductive anatomy. Following this, a speculum is inserted into the vagina to allow access to the cervix, which is then cleansed to minimize the risk of infection. A small-diameter flexible catheter is carefully introduced through the cervix into the uterine cavity and advanced to the proximal tubal ostium, the opening of the fallopian tube. Contrast media is subsequently instilled into the fallopian tube to evaluate its patency, meaning whether it is open or blocked. If an obstruction is detected in the proximal tube, the physician may attempt to recanalize it using a guidewire, potentially in conjunction with a coaxial catheter. This process may be repeated on the opposite side if necessary. Additionally, if both the uterus and fallopian tubes are to be evaluated, contrast is instilled into the uterine cavity, enhancing the diagnostic capability of the procedure.

1. Indications

The transcervical introduction of a fallopian tube catheter, as described by CPT® Code 58345, is indicated for the following conditions:

Infertility Evaluation: This procedure is often performed as part of the workup for infertility to assess the patency of the fallopian tubes.
Diagnosis of Tubal Obstruction: It is utilized to diagnose any blockages in the fallopian tubes that may be contributing to infertility.
Re-establishing Patency: The procedure may be indicated for patients with previously diagnosed tubal obstruction, where re-establishing the patency of the fallopian tubes is necessary for potential conception.

2. Procedure

The procedure involves several key steps to ensure accurate diagnosis and treatment:

Step 1: Baseline Transvaginal Ultrasound: Initially, a baseline transvaginal ultrasound is performed to evaluate the reproductive anatomy and identify any abnormalities that may affect the procedure.
Step 2: Speculum Insertion: After the ultrasound, the vaginal probe is removed, and a speculum is inserted into the vagina to provide access to the cervix.
Step 3: Cervical Cleansing: The cervical os is then cleansed with an antiseptic solution to reduce the risk of infection during the procedure.
Step 4: Catheter Placement: Using fluoroscopic guidance, which is a separate reportable service, a small-diameter flexible catheter is carefully introduced through the cervix into the uterine cavity and advanced into the proximal tubal ostium.
Step 5: Contrast Media Instillation: Once the catheter is in place, contrast media is instilled into the fallopian tube to evaluate its patency. This step is crucial for determining whether the tube is open or obstructed.
Step 6: Recanalization (if necessary): If an obstruction is identified in the proximal tube, the physician may attempt to recanalize it using a guidewire, with or without the assistance of a coaxial catheter, to restore patency.
Step 7: Repeat on Opposite Side: If indicated, the procedure may be repeated on the opposite fallopian tube to ensure comprehensive evaluation and treatment.
Step 8: Hysterosalpingography (optional): The procedure may be performed with or without hysterosalpingography, where contrast is instilled into the uterine cavity to evaluate both the uterus and fallopian tubes simultaneously.

3. Post-Procedure

After the transcervical introduction of the fallopian tube catheter, patients may be monitored for any immediate complications. It is common for patients to experience mild cramping or discomfort following the procedure, which typically resolves quickly. Patients may be advised to avoid strenuous activities for a short period and to follow up with their healthcare provider to discuss the results of the procedure and any further steps that may be necessary based on the findings. Additionally, any specific post-procedure care instructions should be provided by the physician to ensure optimal recovery and outcomes.

Short Descr	REOPEN FALLOPIAN TUBE
Medium Descr	TRANSCERV FALLOPIAN TUBE CATH W/WO HYSTOSALPING
Long Descr	Transcervical introduction of fallopian tube catheter for diagnosis and/or re-establishing patency (any method), with or without hysterosalpingography
Status Code	Active Code
Global Days	010 - Minor Procedure
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	1 - 150% payment adjustment for bilateral procedures applies.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	2 - Payment restriction for assistants at surgery does not apply to this procedure...
Co-Surgeons (62)	2 - Co-surgeons permitted and no documentation required if the two- specialty requirement is met.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Hospital Part B services paid through a comprehensive APC
ASC Payment Indicator	Office-based surgical procedure added to ASC list in CY 2008 or later without MPFS nonfacility PE RVUs; payment based on OPPS relative payment weight.
Type of Service (TOS)	2 - Surgery
Berenson-Eggers TOS (BETOS)	P5E - Ambulatory procedures - other
MUE	1
CCS Clinical Classification	123 - Other operations on fallopian tubes

50	Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d).
51	Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
GC	This service has been performed in part by a resident under the direction of a teaching physician