CPT® Code 58615

1. Indications

The occlusion of fallopian tubes using a device is indicated for various reasons related to reproductive health and family planning. The primary indications for this procedure include:

• Permanent Contraception This procedure is often performed as a method of permanent birth control for women who have decided not to have any more children.
• Management of Ectopic Pregnancy In some cases, this procedure may be indicated for women who have experienced ectopic pregnancies, as it can help prevent future occurrences.
• Prevention of Future Fertility Women who have medical conditions or other factors that may complicate future pregnancies may also be candidates for this procedure.

2. Procedure

The procedure for occluding the fallopian tubes involves several key steps, which can vary slightly depending on whether a vaginal or suprapubic approach is utilized. The following outlines the procedural steps:

• Step 1: Vaginal Approach If the vaginal approach is chosen, the surgeon begins by making an incision in the posterior fornix of the vagina. This incision allows access to the posterior cul-de-sac, where the fallopian tubes can be reached. Once access is obtained, the surgeon locates the fallopian tube and grasps it in its mid-portion using forceps. This is a critical step as it ensures that the tube is held securely for the application of the occlusion device.
• Step 2: Application of Device After the fallopian tube is grasped, the surgeon places a band, clip, or Falope ring around the loop of the fallopian tube to achieve occlusion. This device effectively blocks the passage of eggs from the ovaries to the uterus. If necessary, the same procedure is repeated on the opposite fallopian tube to ensure complete occlusion.
• Step 3: Suprapubic Approach In cases where the suprapubic approach is utilized, the surgeon makes a small incision just above the pubic bone. The first step in this approach is to identify the fimbriated end of the fallopian tube, which is located by recognizing the round ligament as a separate structure. Once the fallopian tube is identified, it is grasped in the mid-portion with forceps, similar to the vaginal approach.
• Step 4: Device Placement The surgeon then places a band, clip, or Falope ring around the loop of the fallopian tube to occlude it. This step is crucial for achieving the desired outcome of the procedure. As with the vaginal approach, this process is repeated on the opposite side as needed to ensure both fallopian tubes are effectively occluded.

3. Post-Procedure

After the procedure, patients may be monitored for a short period to ensure there are no immediate complications. Post-procedure care typically includes instructions for managing any discomfort, such as pain relief medications if necessary. Patients are advised to avoid strenuous activities for a specified period to allow for proper healing. Follow-up appointments may be scheduled to assess recovery and address any concerns. It is important for patients to understand that this procedure is intended as a permanent form of contraception, and they should discuss any future reproductive plans with their healthcare provider.