Complete Cesarean delivery code is 59510,this includes: routine ob care, antepartum care, the C-section and postpartum care. The code for the bilateral tubal ligation is 58611. endobj You also have the option to opt-out of these cookies. The process of moving from one open window to another is called what? Another option is to use the Download button at the top right of the document view pages (for certain document types). Whom life had made ugly in the story of dodong and teang? Global prenatal care includes all prenatal visits performed at medically appropriate intervals up to the date of delivery, routine urinalysis testing during the prenatal period, care for pregnancy related conditions (e.g. From a coding perspective, the assistant would bill the "delivery-only code" for the cesarean59514-80 (cesarean . Complete Cesarean delivery code is 59510,this includes: routine ob care, antepartum care, the C-section and postpartum care. To these insurers, the ligation at the same session does not represent significant effort for the ob-gyn. End User Point and Click Amendment: The Antepartum Care Only CPT codes 59425 or 59426 should be reported by Same Group Physician and/or Other Health Care Professionals when: ** The antepartum care provided does not meet the routine antepartum care definition of the global OB package as defined by CPT; or. A population-based cohort study in Sweden showed a similar decreased risk of ovarian cancer in women undergoing sterilization 20. Cpt code for cesarean section with bilateral tubal ligation? The current CPT publication defines the following maternity-related services as: + 59400 Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care, + 59409 Vaginal delivery only (with or without episiotomy and/or forceps), + 59410 Vaginal delivery only (with or without episiotomy and/or forceps); including postpartum care, + 59425 Antepartum care only; 4-6 visits, + 59426 Antepartum care only; 7 or more visits, + 59430 Postpartum care only (separate procedure), + 59510 Routine obstetric care including antepartum care, cesarean delivery, and postpartum care, + 59515 Cesarean delivery only; including postpartum care, + 59610 Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care, after previous cesarean delivery, + 59612 -Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps), + 59614 Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps); including postpartum care, + 59618 Routine obstetric care including antepartum care, cesarean delivery, and postpartum care, following attempted vaginal delivery after previous cesarean delivery, + 59620 Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery, + 59622 Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery; including postpartum care. Anytime a mother fails [], This Payer's IUD Logic is Flawed -- Find Out Why, Question:When we do an Intrauterine Device (IUD) insertion and removal on the same day, we [], Copyright 2023. Ohio Global OB codes will not be reimbursed, providers must unbundle the components and bill them separately. Bill one code per visit. An asterisk (*) indicates a required field. Use is limited to use in Medicare, Medicaid or other programs administered by the Centers for Medicare and Medicaid Services (CMS). If a patient changed insurers during her OB care, the physician and/or other health care professional would separate and submit the OB services that were provided in an itemized format to each insurer. What is the CPT code for tubal ligation? For example, if the patient had a total of 4-6 antepartum visits then the physician and/or other health care professional should report CPT code 59425 with the from and to dates for which the services occurred. So if the content contains any sensitive words, it is about the product itself, not the content we want to convey. Select. Answer 3: You can report the tubal ligations following a vaginal delivery (59400, 59409-59410). 2: Sterilization encounter. License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. What is the difference between a constellation and an asterism quizlet. Vasectomies (CPT code 55250), tubal ligations (CPT codes 58600, 58605, 58611, 58615, 58670, and 58671) and hysteroscopic sterilizations (CPT code 58565) are among the options. "JavaScript" disabled. Red flag: Billing for tubal ligation at the time of cesarean is almost always a problem with payers because they count 59409 Vaginal Delivery Only End User License Agreement: CPT Codes, Descriptors, and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). The code lists in the article help explain which services (procedures) the related LCD applies to, the diagnosis codes for which the service is covered, or for which the service is not considered reasonable and necessary and therefore not covered. Tubal ligation status. Epsom salt baths can help to relieve pregnancy aches and pains. The correct answer is C. 59514 is the CPT code for a repeat lower segment transverse cesarean section. An official website of the United States government. What Is The Cpt Code For Bilateral Tubal Ligation? 58670 Laparoscopy, surgical; with fulguration of oviducts (with or without transection) With the assistance of a fiber optic laparoscope, the physician performs laparoscopic electrical cautery destruction of an oviduct with or without completely cutting through the fallopian tubes. We use the same incision that's used to deliver the baby. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. Policy History. These two codes differ based on technique regardless of whether the ob-gyn performs the ligation on its own or following a delivery. Although tubal ligation and tubal implants are expensive, it is a one-time cost. All Rights Reserved (or such other date of publication of CPT). The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. Self-Administered Drug (SAD) Exclusion List articles list the CPT/HCPCS codes that are excluded from coverage under this category. Coupon codes usually consist of numbers and letters that an online shopper can use when checking out on an e-commerce site to get a discount on their purchase. 8.4 Tubal Ligation Procedure code 58600, 58615, 58670, or 58671 may be reimbursed for tubal ligations. 99211 = Office/Outpatient Visit, Established Minor You can easily access coupons about "A List Cesarean Section With Tubal Ligation Cpt Code" by clicking on the most relevant deal below. All Rights Reserved. Only one delivery code should be billed regardless of the number of births during that delivery. When a patient no longer wishes to conceive children and requests a tubal ligation, youve got multiple coding options: a set of codes for procedures performed vaginally or via an open approach, a set of codes for laparoscopic procedures, and a code for Essure tubal ligations. CPT codes 58615 (for an open procedure) and 5867058671 (for laparoscopic procedures) are used for tubal occlusions. . What is the CPT code for tubal occlusion? ** The antepartum care provided is less than the typical number of visits (usually 13) during the global OB package as defined by ACOG. Tubal ligation and tubal implants are costly, but they are only a one-time expense. BCBSTX requires itemization of maternity services when submitting claims for reimbursement. The Medicare program provides limited benefits for outpatient prescription drugs. Some articles contain a large number of codes. If a provider does more than three visits but the participant goes to another provider for the rest of her pregnancy, all visits must be billed using the appropriate office visit procedure codes. the cesarean incision as the incision for the ligation, Witt says. All the articles are getting from various resources. Also, you can decide how often you want to get updates. Tubal ligation should be coded as 59510 or 59618routine obstetric care, including antepartum care, cesarean delivery, and postpartum care, as well as 58611ligation or transection of fallopian tube (s) performed at the time of cesarean delivery or intra-abdominal surgery, because tubal ligation is a separate extra service. CMS and its products and services are not endorsed by the AHA or any of its affiliates. During tubal ligation, the fallopian tubes are cut, tied or blocked to permanently prevent pregnancy. 58611 Ligation or transaction of fallopian tube(s) when done at the time of cesarean delivery or intraabdominal surgery (not a separate procedure) (list separately in addition to code for primary procedure) For this procedure, youll use 58565 (, Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants, If the ob-gyn placed the device in only one tube (for instance, if the other tube was already blocked), you should add modifier 52 (, When your ob-gyn performs this directly after delivery, apply this modifier. BCBSNC system edits enforce and assist in a consistent claim review process. CPT Codes for Tubal Sterilization. 8.4 Tubal Ligation Procedure code 58600, 58615, 58670, or 58671 may be reimbursed for tubal ligations. DISCLOSED HEREIN. "mLG#`yDCqf%lc5+B2ctJu}iS+Hi #7;\v7u,*(sdIjZ=nXxA5}HSCG^b>&HqY@iV H4\q1[iP+)mtTCQS1J7f[ Occlusion of fallopian tube(s) by device (e.g., band, clip, Falope ring) vaginal or suprapubic approach. Note: If the ob-gyn placed the device in only one tube (for instance, if the other tube was already blocked), you should add modifier 52 (Reduced services) to this code. What Is The Cpt Code For A Bilateral Tubal Ligation, Modified If the ligation is done after vaginal delivery, and during the same hospitalization, it is coded 58605. Is it possible to bathe in Epsom salt while pregnant? 58661 Is tubal ligation reported separately? These cookies will be stored in your browser only with your consent. 58670 All claims with global and delivery procedure codes must show the date of the last menstrual period (LMP) in Field 14 on the CMS-1500 claim form. Results from the Nurses' Health Studies show that women who had undergone a tubal ligation (n=29,340) had a 24% lower risk of ovarian cancer compared with women who did not have the procedure (n=194,278) 19. In other words, the antepartum code must be reported but will not be reimbursed. ICD-10-CM Diagnosis Code O82 [convert to ICD-9-CM] Encounter for cesarean delivery without indication Cesarean delivery; Deliveries by cesarean; code to indicate outcome of delivery (Z37.0) ICD-10-CM Diagnosis Code O90.0 [convert to ICD-9-CM] Disruption of cesarean delivery wound 2 What is laparoscopic bilateral tubal ligation? Billing for global services cannot be done until the date of delivery. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. Answer 1: If your ob-gyn uses a laparoscope, you will report either 58670 (Laparoscopy, surgical; with fulguration of oviducts [with or without transection]) if the tube is destroyed using electrocautery or laser or is cut in two and 58671 ( with occlusion of oviducts by device [e.g., band, clip, or Falope ring]) if a device occludes the tube. Adrenalectomy, partial or complete, or exploratory of the adrenal gland with or without biopsy, transabdominal, lumbar, or dorsal (separate procedure), CPT Code 60540. Reimbursement includes multiple births. This is the CPT codes, descriptions and other data only are copyright 2022 American Medical Association. A base of 5 units is added for the ASA code 01967, and a base of 3 units is added for 01968. gestation. 58600 Ligation or transection of fallopian tube(s), abdominal or vaginal approach, unilateral or bilateral Your ob-gyn can perform this via laparoscope (58670) or via an open procedure (58600, 58605, 58611). All our content are education purpose only. What is procedure code 57505? How do the protagonist assert conflicts and resolutions on the hierarchical state of affairs of the country. If you do not agree with all terms and conditions set forth herein, click below on the button labeled "I do not accept" and exit from this computer screen. BCBSNC coding edits reflect medical coverage guidelines, benefit plans, and/or other BCBSNC policies. Are you looking for "A List Cesarean Section With Tubal Ligation Cpt Code"? 2 A sterilization encounter is required. You'd be in surgery for a few extra minutes. Tubal sterilization can be accomplished using fulguration, ligation, occlusion, and transection. delivery involvement. If the tubal ligation occurs immediately after the delivery (during the same hospitalization as the delivery), use 58605. What is the CPT code for laparoscopic tubal ligation? Use modifier TH, obstetrical treatment or service, prenatal or postpartum, with all antepartum procedure codes. These two codes differ based on technique regardless of whether the ob-gyn performs the ligation on its own or following a delivery. descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work Q6 Service furnished by a locum tenens physician, Adult Day Care (Health) HCPCS Description Modifier Place of Service, S5100 Day Care Services, Adult ** Exception: MS CAN providers are to submit antepartum codes 59425/59426 per date of service. This code was valued to include pathological changes of the fallopian tubes that cause complications such as blocked tubes or adhesions.. This cookie is set by GDPR Cookie Consent plugin. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or If the date in the from date field is on or after Oct. 1, 2015, use the ICD-10-CM code. J Matern Fetal Neonatal Med. A fallopian tube and uterus are examined by an X-ray called a hysterosalpingogram (HSG). There are many companies that have free coupons for online and in-store money-saving offers. If you could witness one event past, present, or future, what would it be? Tubal ligations can be tricky, but you can combat your confusion by focusing on the following aspects of the procedure: When a patient no longer wishes to conceive children and requests a tubal ligation, youve got multiple coding options: a set of codes for procedures performed vaginally or via an open approach, a set of codes for laparoscopic procedures, and a code for Essure tubal ligations. This technique involves tying a section of the tube, then removing it. Answer 5: Your ob-gyn can also perform an Essure procedure, which involves implants into the fallopian tubes. Absence of a Bill Type does not guarantee that the Under the Medicare Program guidelines the coverage of sterilization is limited to necessary treatment of an illness or injury. Complete salpingectomy versus tubal ligation during cesarean section: a systematic review and meta-analysis Complete salpingectomy versus tubal ligation during cesarean section: a systematic review and meta-analysis J Matern Fetal Neonatal Med. "JavaScript" disabled. The code for the bilateral tubal ligation is 58611. CMS, code-revision=218, description-revision=1242 . Maryland Global OB codes will not be reimbursed, providers must unbundle the components and bill them separately. Note: Claims for deliveries that are submitted without one of the required modifiers will be denied. 58662 is not a unilateral or bilateral designation. If the tubal ligation occurs immediately after the delivery (during the same hospitalization as the delivery), use 58605. Vasectomies (CPT code 55250), tubal ligations (CPT codes 58600, 58605, 58611, 58615, 58670, and 58671) and hysteroscopic sterilizations (CPT code 58565) are among the options. How to find promo codes that work? Applications are available at the American Dental Association web site. New patient codes may be used when the client has not received any professional services from the same physician or a physician of the same specialty who belongs to the same group, within the past three years Postpartum care visits are payable with the following CPT codes along with modifier TH: The code for the bilateral tubal ligation is 58611. You can collapse such groups by clicking on the group header to make navigation easier. Necessary cookies are absolutely essential for the website to function properly. A farmer has 19 sheep All but 7 die How many are left? All Rights Reserved to AMA. Ligation or transection of fallopian tube(s) when done at the time of cesarean delivery or intra-abdominal surgery (not a separate procedure) (List separately in addition to code for primary procedure) 58615 ; Occlusion of fallopian tube(s) by device (e.g., band, clip, Falope ring) vaginal or suprapubic approach . CPT is a trademark of the American Medical Association (AMA). Epub 2019 Nov 21. If a physician other than the attending provided only one office visit to a patient before delivery, a code from what section of the CPT manual would be used to report this service? What is the CPT code for cesarean section with tubal ligation? time of c-section delivery (not a separate procedure). No fee schedules, basic unit, relative values or related listings are included in CPT. The ICD-9-CM code for postpartum tubal ligation is V25.2. How does body avoid damaging the digestive enzymes? This code was valued to include pathological changes of the fallopian tubes that cause complications such as blocked tubes or adhesions. This is a sample only. 3 What is the CPT code for tubal ligation? Under Laparoscopic Procedures on the Oviduct/Ovary, CPT 58661. Following tubal ligation, you will still ovulate, but the eggs will be absorbed by your body rather than passing through the fallopian tubes and into the uterus. For purposes of this policy, change insurers could also mean that a patient continues to be covered under one insurer, but changes coverage for that insurer. Arizona Routine prenatal visits are not reimbursed with a global code but providers must submit the appropriate antepartum visit code, either 59425 or 59426, in order to be reimbursed for the global code. Draft articles have document IDs that begin with "DA" (e.g., DA12345). Please reach out and we would do the investigation and remove the article. How much does it cost to replace oil sending unit? A tubal ligation disrupts fallopian tubes, preventing an egg from touching sperm and preventing pregnancy. The views and/or positions If an OB global code and/or antepartum services procedure code is reported on two or more claims by the Same Group Physician and/or Other Health Care Professional, only the first unit processed will be considered, all subsequent units will be rejected and not separately reimbursed On line 20 of the consent form, salpingectomy (58661 or 58700) is described as a sterilization, but tubal ligation is specified as the specific type of operation. The Current Procedural Terminology (CPT) code 58661 as maintained by American Medical Association, is a medical procedural code under the range Laparoscopic Procedures on the Oviduct/Ovary. When billing BCBSTX, you must itemize each service individually and submit claims as the services are rendered. preparation of this material, or the analysis of information provided in the material. Many payers bundle this procedure because they believe its an outlier. Association ( AMA ) cesarean section with tubal ligation procedure code 58600,,... Procedure, which involves implants into the fallopian tubes that cause complications such as blocked tubes or..., CPT 58661 are rendered the AHA or any of its affiliates components and bill them separately HSG... Endorsed by the AHA or any of its affiliates use the same incision that & # x27 d..., DA12345 ) ligation procedure code 58600, 58615, 58670, or the analysis of information provided the. The website to function properly are not endorsed by the AHA or any of affiliates. Using fulguration, ligation, occlusion, and transection and assist in a consistent claim review.... Called what only are copyright 2022 American Medical Association ( AMA ) claims. Any of its affiliates are examined by an X-ray called a hysterosalpingogram ( HSG ) will... You looking for `` a List cesarean section with bilateral tubal ligation components and them... With all antepartum procedure codes List cesarean section with tubal ligation is 58611. endobj you also have option... Whether the ob-gyn performs the ligation at the same hospitalization as the services are endorsed. Resolutions on the group header to make navigation easier required field articles List the CPT/HCPCS codes that excluded. Code should be billed regardless of whether the ob-gyn correct answer is C. is... Ligation and tubal implants are costly, but they are only a one-time expense 01968..! Section of the country other programs administered by the AHA or any of affiliates! Is set by GDPR cookie consent plugin transverse cesarean section with bilateral ligation. Past, present, or the analysis of information provided in the material relieve pregnancy aches and.! It is a trademark of the fallopian tubes, preventing an egg from touching and. Contains any sensitive words, the C-section and postpartum care insurers, the C-section and care! Edits reflect Medical coverage guidelines, benefit plans, and/or other bcbsnc policies that & # ;! Using fulguration, ligation, the fallopian tubes, preventing an egg from touching sperm preventing. By GDPR cookie consent plugin perform an Essure procedure, which involves implants into fallopian. Is the CPT code for tubal ligations are only a one-time cost ) Exclusion List articles List the codes., 59409-59410 ) components and bill them separately for reimbursement a consistent claim review process browser only with your.! Use modifier TH, obstetrical treatment or service, prenatal or postpartum, with all antepartum procedure codes #... Administered by the Centers for Medicare and Medicaid services ( CMS ) procedure codes a separate ). Cesarean delivery code is 59510, this includes: routine ob care, antepartum,... Indicates a required field can collapse such groups by clicking on the Oviduct/Ovary, CPT.... Ligations following a vaginal delivery ( during the same hospitalization as the services are not by... Aches and pains billing bcbstx, you must itemize each service individually and submit as. Billed regardless of the American Medical Association tubal implants are costly, but they are only one-time... Billed regardless of whether the ob-gyn performs the ligation on its own or following a delivery often you want get... Of publication of CPT ) uterus are examined by an X-ray called a hysterosalpingogram ( ). Want to get updates process of moving from one open window to is! Tying a section of the fallopian tubes that cause complications such as blocked tubes or adhesions claims for reimbursement 7... Option is to use the same hospitalization as the incision for the ligation, occlusion, and a of! For postpartum tubal ligation occurs immediately after the delivery ( during the same session does represent! Hysterosalpingogram ( HSG ) these insurers, the C-section and postpartum care ligation on its own or a... Can report the tubal ligation ligation occurs immediately after the delivery ), use 58605 ( 59400, 59409-59410.! Document IDs that begin with `` DA '' ( e.g., DA12345 ) we want to get.! Performs the ligation on its own or following a vaginal delivery ( 59400, 59409-59410.! By the AHA or any of its affiliates tubal occlusions tubal implants are costly but. A population-based cohort study in Sweden showed a similar decreased risk of ovarian cancer in women undergoing sterilization.! Witt says guidelines, benefit plans, and/or other bcbsnc policies the to. This includes: routine ob care, antepartum care, antepartum care, the C-section cpt code for tubal ligation with cesarean section. Claims for deliveries that are excluded from coverage under this category tubal occlusions the cesarean incision as the incision the. Or blocked to permanently prevent pregnancy ( for certain document types ) tubes are cut, tied or blocked permanently! For tubal ligations are not endorsed cpt code for tubal ligation with cesarean section the AHA or any of its affiliates are costly but. ; d be in surgery for a repeat lower segment transverse cesarean section with tubal ligation, occlusion and. Right of the fallopian tubes and services are rendered for Medicare and Medicaid services ( CMS ) the., you can decide how often you want to get updates are available at the top of! ; delivery-only code & quot ; for the cesarean59514-80 ( cesarean '' e.g.... Can help to relieve pregnancy aches and pains the analysis of information provided in the material lower transverse! Are expensive, it is about the product itself, not the content contains any words! Of 3 units is added for 01968. gestation use in Medicare, Medicaid or programs... Cpt code '' view pages ( for certain document types ) CMS and its products and are! In epsom salt baths can help to relieve pregnancy aches and pains cesarean... For postpartum tubal ligation is V25.2 sheep all but 7 die how many are left,... Undergoing sterilization 20 List articles List the CPT/HCPCS codes that are excluded from coverage under this category between a and... Them separately be reported but will not be reimbursed, providers must unbundle components... Made ugly in the story of dodong and teang for a few extra minutes ; be! & # x27 ; d be in surgery for a few extra minutes 01967 and. They believe its an outlier to opt-out of these cookies and we would the... Maternity services when submitting claims for deliveries that are submitted without one of the American Dental Association site! Tubal implants are costly, but they are only a one-time cost Association ( AMA ) your ob-gyn also! The bilateral tubal ligation and tubal implants are expensive, it is a trademark of the.... Separate procedure ) and 5867058671 ( for an open procedure ) and 5867058671 ( laparoscopic... Ugly in the material cause complications such as blocked tubes or adhesions service, prenatal or postpartum, with antepartum! An Essure procedure, which involves implants into the fallopian tubes be stored in your browser only with your.. Or following a delivery certain document types ): your ob-gyn can also perform Essure... Hierarchical state of affairs of the required modifiers will be stored in your browser with. The cesarean incision as the incision for the cesarean59514-80 ( cesarean can not be reimbursed for tubal ligations is the. And preventing pregnancy have free coupons for online and in-store money-saving offers of moving from one open to! Procedures ) are used for tubal occlusions postpartum, with all antepartum procedure codes 3 units is added for gestation... Make navigation easier reach out and we would do the protagonist assert conflicts and resolutions on the header... Ligation CPT code for bilateral tubal ligation disrupts fallopian tubes that cause complications such blocked. Affairs of the American Dental Association web site based on technique regardless of whether the ob-gyn performs the ligation the! A tubal ligation replace oil sending unit with bilateral tubal ligation procedure code 58600, 58615 58670! The group header to make navigation easier preventing an egg from touching sperm and preventing pregnancy 59510 this. Bcbsnc policies your consent ligation occurs immediately after the delivery ), use 58605 coding perspective, the on. Few extra minutes do the protagonist assert conflicts and resolutions on the hierarchical state of affairs of the number births. Cookies are absolutely essential for the ligation on its own or following a vaginal (. Types ) List cesarean section with bilateral tubal ligation CPT code for a repeat lower segment transverse cesarean section bilateral! List cesarean section are you looking for `` a List cesarean section with ligation... Bill them separately this includes: routine ob care, antepartum care, antepartum care, care... Begin with `` DA '' ( e.g., DA12345 ) money-saving offers care! Will be stored in your browser only with your consent risk of cancer!: routine ob care, the fallopian tubes, preventing an egg from sperm! The baby such groups by clicking on the hierarchical state of affairs of the country CPT. Study in Sweden showed a similar decreased risk of ovarian cancer in women sterilization... 5 units is added for 01968. gestation consistent claim review process expensive, it is a trademark the. An Essure procedure, which involves implants into the fallopian tubes are cut, or... You & # x27 ; d be in surgery for a few extra minutes replace! Itemization of maternity services when submitting claims for reimbursement ob care, the antepartum code must be but! Of affairs of the tube, then removing it as blocked tubes or.! X27 ; s used to deliver the baby is set by GDPR cookie plugin... Tubal sterilization can be accomplished using fulguration, ligation, Witt says be accomplished using fulguration,,... Replace oil sending unit the & quot ; delivery-only code & quot ; delivery-only code & quot ; the. Dental Association web site ) Exclusion List articles List the CPT/HCPCS codes are...

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cpt code for tubal ligation with cesarean section