CPT 59830: Removal of Products of Conception for Severe Uterine Infection
CPT code 59830 denotes a vaginal surgical procedure to remove products of conception that are causing a severe uterine infection. This intervention is clinically important because retained gestational tissue with infection can lead to sepsis, hemorrhage, and prolonged morbidity if not evacuated. Nationally, 59830 is a focused, acute gynecologic procedure performed in hospital settings and is relevant to obstetrics and gynecology, emergency care, and inpatient surgical services.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of the clinical context for use of CPT code 59830, typical sites of service, common modifiers encountered on claims, and the payer landscape addressed. The publication offers benchmarks where available, summarizes policy considerations that affect coverage and payment for acute evacuation procedures, and outlines coding and billing nuances that influence claim adjudication and reimbursement. The content is designed to inform coding professionals, practice managers, and policy analysts about clinical indications, administrative considerations, and payer coverage trends related to this acute gynecologic surgical code.
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Billing Code Overview
CPT code 59830 describes a surgical procedure in which the provider removes products of conception that are causing a severe uterine infection via a vaginal approach. This procedure is performed to manage persistent intrauterine infection when retained gestational tissue is identified as the source.
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Service type: Surgical gynecologic procedure for removal of retained products of conception
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Typical site of service: Hospital operating room or procedure suite with vaginal approach under appropriate anesthesia
Clinical & Coding Specifications
Clinical Context
A typical patient is a reproductive-age woman presenting to the emergency department or gynecology clinic with fever, lower abdominal pain, uterine tenderness, and purulent vaginal discharge following a recently completed pregnancy event (spontaneous abortion, retained products after delivery, or recent termination). After initial evaluation including vital signs, pelvic exam, laboratory studies (complete blood count, inflammatory markers), pregnancy test, and pelvic ultrasound showing retained products of conception with evidence of endometritis or sepsis, the gynecology team determines that removal of retained products via a vaginal approach is required to control infection and prevent progression to severe sepsis. The clinical workflow includes stabilization (IV fluids, broad-spectrum IV antibiotics), informed consent, preoperative assessment, anesthesia consultation (typically general or regional anesthesia), performance of the procedure in an operating room or procedure suite via suction curettage or sharp curettage transvaginally, intraoperative specimen collection for pathology and culture, and postoperative monitoring with continued antibiotics until clinical improvement. Common settings include the hospital inpatient operating room, ambulatory surgery center for stable patients, or emergency operating room for unstable patients requiring urgent source control.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier; standard reporting | Use when no additional modifier applies to the procedure billing. |
11 | Office/Outpatient or standard service | Use to indicate the usual, uncomplicated service when required by payors accepting this modifier for standard service. |
22 | Increased procedural services | Use when the procedure required significantly greater effort, time, or technical difficulty due to infection, extensive adhesions, or hemorrhage. |
23 | Unusual anesthesia | Use when general or regional anesthesia is required due to patient condition beyond local anesthesia tolerance. |
26 | Professional component | Use when separately billing the physician professional component distinct from facility technical component (rare for this surgical procedure). |
47 | Anesthesia by surgeon | Use when the surgeon provides regional or general anesthesia and billing policies permit modifier 47. |
50 | Bilateral procedure | Use if the procedure is reported as bilateral when clinical circumstances and coding guidance support bilateral reporting (rare for uterine procedure). |
52 | Reduced services | Use when a reduced service is performed (e.g., aborted attempt due to instability) and full procedure not completed. |
53 | Discontinued procedure | Use when procedure is started but discontinued without completion for patient safety reasons. |
63 | Procedure performed on infants less than 4 kg | Use only when applicable for neonatal patients meeting weight criteria. |
66 | Surgical team approach | Use when an organized surgical team provided services and payer requires this modifier. |
78 | Return to OR for related procedure during global period | Use when patient requires a return to the operating room for a related procedure due to complications of the initial procedure. |
80 | Assistant at surgery | Use when a surgical assistant participates and the payer requires modifier 80 for reimbursement. |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist signature | Use when an advanced practice clinician performs or assists and payer requires AS to identify their role. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207P00000X | Obstetrics & Gynecology | Board-certified OB/GYNs commonly perform this procedure. |
| 207VP0800X | Gynecologic Oncology | Gynecologic oncologists may perform when malignancy or complex infection is a concern. |
| 363A00000X | Family Medicine | Family physicians with surgical gynecology training may perform in certain settings. |
| 208000000X | General Surgery | General surgeons may perform in emergency settings when gynecology not available. |
| 364S00000X | Emergency Medicine | Emergency physicians may participate in initial stabilization and coordination; procedural performance varies by privileging. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
O03.8 | Other spontaneous abortion with other complications | Retained products after spontaneous abortion can lead to infection requiring removal. |
O03.9 | Spontaneous abortion, unspecified | Used when spontaneous abortion is the underlying event leading to retained products and infection. |
O08.3 | Retained products of conception following delivery | Direct indication for evacuation to control infection after delivery. |
O86.0 | Puerperal sepsis | Severe uterine infection postpartum that may necessitate prompt surgical removal of products. |
N71.0 | Acute inflammatory disease of uterus, not elsewhere classified | Endometritis with retained tissue may be coded here when infection is primary diagnosis. |
A41.9 | Sepsis, unspecified organism | Systemic infection secondary to retained products; supports urgency of evacuation. |
O07.1 | Failed attempted termination of pregnancy with other complications | May be associated with retained tissue and infection requiring removal. |
O07.9 | Failed attempted termination of pregnancy, unspecified | Used when failed termination results in retained products and infection. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
59820 | Dilation and curettage, postpartum or postabortion, nonemergency | Often used for removal of retained products in less severe infection or nonseptic presentations; alternative code depending on timing and clinical context. |
59821 | Dilation and evacuation, second trimester, nonemergency | Used when retained products require evacuation beyond first trimester techniques; relevant if gestational age and technique differ. |
58120 | Endometrial sampling (biopsy) without anesthesia | May be performed preoperatively for diagnostic sampling when infection is less severe and anesthesia not required. |
51701 | Insertion of indwelling bladder catheter (e.g., Foley) | Frequently performed preoperatively intraoperatively for urinary drainage during surgery and postoperative recovery. |
99024 | Postoperative follow-up visit, global period | Used for reporting routine postoperative follow-up care during the global period by the surgeon or clinic. |