CPT® Code 59121

1. Indications

The surgical treatment of ectopic pregnancy using CPT® Code 59121 is indicated in the following scenarios:

• Ovarian Ectopic Pregnancy The procedure is performed when a fertilized egg implants in the ovary, necessitating surgical intervention to remove the ectopic tissue while preserving the ovary.
• Tubal Ectopic Pregnancy This procedure is indicated when the ectopic pregnancy occurs within the fallopian tube, requiring surgical access to remove the ectopic tissue without excising the tube itself.

2. Procedure

The surgical procedure for CPT® Code 59121 involves several critical steps to ensure the safe removal of the ectopic pregnancy while preserving the fallopian tube and/or ovary.

• Step 1: Accessing the Ectopic Pregnancy An incision is made either in the abdomen or through the vagina to expose the fallopian tube and/or ovary. This access allows the surgeon to visualize and manipulate the affected area effectively.
• Step 2: Dissection of the Ectopic Tissue For an ovarian ectopic pregnancy, the surgeon grasps the ovary and carefully dissects the ectopic tissue from it using both blunt and sharp dissection techniques. This step is crucial to ensure that the ovary remains intact while the ectopic tissue is removed.
• Step 3: Control of Bleeding During the dissection, any bleeding that occurs is controlled using electrocautery, which helps to minimize blood loss and maintain a clear surgical field.
• Step 4: Management of Tubal Ectopic Pregnancy In cases of tubal ectopic pregnancy, an incision is made on the antimesenteric side of the fallopian tube. The ectopic pregnancy is then dislodged by injecting saline deep into the tube using an aquadissector or syringe, facilitating the removal of the products of conception.
• Step 5: Irrigation and Removal The tube is irrigated at the site of the ectopic pregnancy to ensure that all products of conception are removed. This step is vital for preventing complications such as infection or further bleeding.
• Step 6: Finalizing the Procedure After the ectopic tissue is removed, any remaining bleeding is controlled through electrocautery or suture ligation of vessels. The incision made in the fallopian tube is intentionally left open to heal by secondary intention, allowing for natural healing processes to occur.
• Step 7: Alternative Techniques In some cases, a tubal pregnancy may be evacuated from the fimbriated end of the tube without making an incision. This can be achieved by milking the tube to express the pregnancy or by grasping the fimbria, injecting saline, and irrigating to remove the products of conception.

3. Post-Procedure

Post-procedure care following the surgical treatment of ectopic pregnancy using CPT® Code 59121 typically involves monitoring for any signs of complications, such as excessive bleeding or infection. Patients may be advised to rest and avoid strenuous activities for a specified period to facilitate recovery. Follow-up appointments are essential to ensure proper healing and to assess the patient's reproductive health. Additionally, healthcare providers may discuss future pregnancy planning and the implications of having experienced an ectopic pregnancy.