CPT® Code 59136

1. Indications

The procedure associated with CPT® Code 59136 is indicated for the management of an interstitial pregnancy, which is a specific type of ectopic pregnancy. The following conditions warrant this surgical intervention:

• Interstitial Pregnancy This condition occurs when the gestational sac implants within the interstitial segment of the fallopian tube, which is embedded in the muscular wall of the uterus, leading to potential complications.
• Life-threatening Situations Due to the risk of rupture and significant hemorrhage associated with interstitial pregnancies, surgical intervention is necessary to prevent life-threatening complications.
• Diagnosis Confirmation Prior diagnostic laparoscopy is performed to confirm the presence of an interstitial ectopic pregnancy and to accurately identify the location of the gestational sac.

2. Procedure

The surgical procedure for CPT® Code 59136 involves several critical steps to effectively manage the interstitial pregnancy:

• Step 1: Diagnostic Laparoscopy Before the surgical treatment, a diagnostic laparoscopy is performed to confirm the diagnosis of interstitial ectopic pregnancy. This minimally invasive procedure allows the surgeon to visualize the reproductive organs and locate the gestational sac accurately.
• Step 2: Abdominal Incision An incision is made in the abdomen over the site of the interstitial pregnancy. This incision provides access to the anterior surface of the uterus, which is essential for the subsequent surgical steps.
• Step 3: Uterine Injection The uterus is injected with diluted vasopressin. This step is crucial as it helps to constrict blood vessels, minimizing blood loss during the procedure.
• Step 4: Incision on Uterine Bulge A careful incision is made along the bulge of the uterus using a monopolar electrosurgical cutting device. This technique allows for precise cutting while reducing thermal damage to surrounding tissues.
• Step 5: Dissection of Uterine Tissue The portion of the uterus containing the interstitial pregnancy is meticulously dissected free from the surrounding myometrial tissue. This step is performed with caution to preserve as much healthy uterine tissue as possible.
• Step 6: Removal of Gestational Sac The gestational sac is removed along with the most conservative amount of uterine tissue necessary to ensure complete excision of the ectopic tissue.
• Step 7: Uterine Repair After the removal of the gestational sac, the myometrium is approximated, and the uterus is repaired using either a figure-of-8 configuration or running mattress sutures. This repair technique is essential for restoring the integrity of the uterine wall and promoting proper healing.

3. Post-Procedure

Post-procedure care following the surgical treatment of an interstitial pregnancy involves monitoring for any signs of complications, such as excessive bleeding or infection. Patients are typically advised to rest and may require pain management. Follow-up appointments are essential to assess the healing process and ensure that there are no residual complications from the surgery. Additionally, patients may be counseled regarding future pregnancies and the potential risks associated with a history of ectopic pregnancy.