Summary & Overview
CPT 59136: Interstitial Ectopic Pregnancy Resection, Abdominal Approach
CPT code 59136 denotes surgical removal of an interstitial (cornual) ectopic pregnancy by excision of the involved fallopian tube segment and adjacent uterine tissue via an abdominal approach. This code captures a distinct gynecologic procedure used for ectopic pregnancies located at the tube-uterus junction and is relevant for hospital surgical billing and obstetrics-gynecology practice patterns nationally. Its use affects surgical case mix, resource utilization, and quality reporting for reproductive health services.
Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for the procedure, typical sites of service, and the core coding definition. The publication also provides benchmarks and comparative policy notes where available, including common billing considerations and payer coverage themes. Additionally, the piece outlines clinical context to help nonclinical stakeholders understand why this code differs from other ectopic pregnancy procedures and where it fits in surgical service lines. Data not available in the input is identified explicitly where applicable.
Billing Code Overview
CPT code 59136 describes an operative procedure to remove an ectopic pregnancy located at the interstitial portion where the fallopian tube meets the uterus. The surgeon excises the affected portion of the fallopian tube and a portion of the uterine wall to remove the ectopic gestation.
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Service type: Surgical procedure — open abdominal gynecologic surgery
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Typical site of service: Inpatient or outpatient hospital surgical setting via an abdominal (laparotomy) approach
Clinical & Coding Specifications
Clinical Context
A 28-year-old woman presents to the emergency department with acute lower abdominal pain, vaginal bleeding, and a positive urine pregnancy test. Transvaginal ultrasound demonstrates an adnexal mass at the tubal-uterine junction suspicious for an ectopic pregnancy (cornual/interstitial location) with concern for tubal rupture or persistent ectopic tissue. The gynecologic surgeon decides to proceed to the operating room for definitive management via an abdominal approach. Under general anesthesia, an abdominal incision (laparotomy or mini-laparotomy) is made, the uterus and ipsilateral fallopian tube are explored, and a wedge resection of the uterine cornu and adjacent tubal segment is performed to remove the ectopic pregnancy. Hemostasis is obtained and the uterus and adnexa are repaired.
Typical workflow steps:
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Emergency evaluation with history, physical exam, vital signs, quantitative beta-hCG, and pelvic/transvaginal ultrasound.
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Preoperative consent including discussion of risks (bleeding, infection, need for salpingectomy or hysterectomy), possible blood transfusion, and fertility implications.
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Pre-op labs, anesthesia evaluation, and surgical site marking.
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Operating room: abdominal approach, resection of interstitial/cornual ectopic with uterine repair (procedure reported with
59136), specimen sent to pathology. -
Postoperative monitoring, pain control, serial beta-hCG until negative if indicated, discharge planning and follow-up with gynecology.
Typical site of service: Hospital inpatient or outpatient surgical suite (OR) — often performed emergently in the hospital setting.
Service type: Operative surgical procedure — abdominal cornuostomy/cornual resection for ectopic pregnancy (open abdominal approach).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default/unspecified (payer-specific) | Use only if required by a payer that uses 00 as a default administrative modifier. |
11 | Usually the correct, or default, billing modifier (CMS internal) | May be used where a carrier requires explicit reporting of the usual charge indicator. |
22 | Increased procedural services | Use when work required to perform 59136 is substantially greater than usually required (document rationale). |
23 | Unusual anesthesia | Use when medically necessary anesthesia is provided for a procedure that is usually performed with local or no anesthesia. |
26 | Professional component | Use when reporting only the physician’s professional component separate from technical services (rare for this OR procedure). |
50 | Bilateral procedure | Use if procedure is performed bilaterally and payer requires bilateral modifier (document bilateral resection). |
51 | Multiple procedures | Use when other unrelated procedures are performed during the same operative session in addition to 59136. |
52 | Reduced services | Use when the procedure is partially reduced or not completed as planned (document reason). |
53 | Discontinued procedure | Use if the procedure was terminated due to extenuating circumstances after anesthesia induction but before completion. |
62 | Two surgeons | Use when two surgeons of different specialties collaborate and each performs a substantive portion of 59136. |
63 | Procedure performed on infants less than 4 kg | Generally not applicable but included when patient size modifier is required by payer. |
73 | Discontinued outpatient procedure prior to anesthesia | Use if outpatient procedure cancelled before anesthesia/operating room. |
78 | Unplanned return to OR for related procedure during global period | Use when patient requires an unplanned reoperation related to the initial 59136 within the global period. |
80 | Assistant surgeon | Use when a surgical assistant is present and assistant fees are billable (document role). |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207V00000X | Obstetrics & Gynecology | Gynecologic surgeons who commonly perform ectopic pregnancy resections. |
207VC0100X | Gynecologic Oncology | May perform complex uterine/tubal resections, especially if malignancy or complex reconstruction is needed. |
207VM0001X | Reproductive Endocrinology/Infertility | May be involved in fertility-preserving surgical decision-making and follow-up. |
208000000X | General Surgery | May assist or manage abdominal access in emergency settings where gynecology is unavailable. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
O00.1 | Tubal pregnancy | Primary diagnosis indicating ectopic implantation in the fallopian tube, typical indication for 59136. |
O00.8 | Ectopic pregnancy of other specified sites | Used when ectopic is at the tubal-uterine junction/cornual region and coded specifically to non-specified sites. |
O00.9 | Ectopic pregnancy, unspecified | Used when location is not specified but ectopic pregnancy necessitates surgical management. |
O02.1 | Missed abortion | Included when distinction between nonviable intrauterine and ectopic process is required during diagnostic workup. |
O03.9 | Spontaneous abortion, incomplete or unspecified | May be present in the differential or concurrent uterine pathology influencing management. |
Note: If payer or facility requires more specific coding (cornual/interstitial ectopic), use the most precise available ICD-10 code in the medical record; the codes above reflect commonly associated diagnoses for surgical management of ectopic pregnancy.
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
58999 | Unlisted procedure, uterus/adnexa | May be used when a closely related, specific CPT is not available for atypical or novel uterine/tubal resections; requires operative report. |
49000 | Exploratory laparotomy, exploratory celiotomy with or without biopsy(s) | Performed when additional abdominal exploration is required prior to or in conjunction with 59136. |
57425 | Colposcopy with ECC (diagnostic) | Not commonly performed intraoperatively for ectopic pregnancy but may be performed in related gynecologic evaluations. |
36556 | Therapeutic, prophylactic, or diagnostic insertion of a central venous catheter (tunneled central venous catheter) | May be billed if perioperative central access is required for transfusion or hemodynamic support in unstable patients. |
36415 | Collection of venous blood by venipuncture | Performed preoperatively for labs such as CBC and type and crossmatch. |
If no payer-specific related CPT codes were provided in the input, the table above lists commonly associated perioperative or related procedures that may be performed before, during, or after 59136.