Summary & Overview
CPT 59100: Early-Gestation Abdominal Cesarean-Type Procedure
CPT code 59100 represents a surgical obstetric procedure: an abdominal approach to remove a fetus or hydatidiform mole from the uterus prior to 20 weeks gestation using smaller-than-standard abdominal and uterine incisions. This code captures a specific early-gestation cesarean-type procedure distinct from routine cesarean deliveries and is relevant for clinical coding, hospital billing, and obstetric surgical classification nationwide. Nationally, correct use of CPT code 59100 affects hospital claims, resource classification, and maternal care episode reporting.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and service setting, an explanation of the procedure’s coding intent, and what aspects are commonly reviewed by payers during claim adjudication. The publication outlines benchmarks and payment context where available, highlights policy updates that influence coding and coverage determinations, and summarizes typical sites of service and clinical scenarios where this code applies. Data not available in the input is noted where applicable. This document is intended for coding professionals, billing managers, and health policy analysts seeking a clear national summary of CPT code 59100 and its role in obstetric surgical billing.
Billing Code Overview
CPT code 59100 describes a surgical procedure performed through an abdominal approach to remove a fetus or hydatidiform mole from the uterus prior to 20 weeks and 0 days gestation. The procedure is a variant of a cesarean section in which both the abdominal and uterine incisions are smaller than those used for a standard cesarean delivery.
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Service type: Surgical obstetric procedure (abdominal approach for early gestational uterine evacuation)
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Typical site of service: Hospital operating room or ambulatory surgical center depending on clinical circumstance and facility capability
Clinical & Coding Specifications
Clinical Context
A 28-year-old gravida 2 para 0 patient at 16 weeks and 3 days gestation is diagnosed with a nonviable pregnancy complicated by a partial molar pregnancy and heavy vaginal bleeding. The obstetrician elects to perform a transabdominal procedure to remove the fetus and molar tissue because uterine size and anatomy make a minimally invasive or transcervical approach unsafe. The patient is admitted to the hospital for preoperative evaluation, informed consent, blood type and screen, and preoperative antibiotics. In the operating room under general anesthesia, the obstetrician makes a smaller-than-standard low transverse abdominal incision and a correspondingly limited uterine incision to extract the fetus and hydatidiform tissue prior to 20 weeks 0 days gestation. Hemostasis is achieved, the uterine incision is closed, and the patient is transferred to recovery for postoperative monitoring. Postoperative workflow includes pathology submission, serial beta-hCG monitoring, and outpatient follow-up for uterine involution and counseling on future pregnancy planning.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | (Not a standard HCPCS/CMS modifier in common use) | Data not available in the input. |
11 |