Q&A column

Q. How do you code fallopian tubes submitted for sterilization with a finding of a paratubal cyst?

A.Current Procedural Terminology (CPT) billing codes are determined based on the average level of effort involved in analyzing a tissue sample. This estimation considers three key variables: physician work, practice expense, and liability insurance factors.¹ Physician work encompasses skill, judgment, and time, which are influenced by factors such as the patient’s medical history, purpose of the procedure, and pathologist’s final diagnosis.

The CPT code for fallopian tube sterilization is 88302. If the surgeon designates each fallopian tube separately, each is assigned its own 88302 code. Incidental paratubal cysts in salpingectomy specimens are common. In a 2020 study, these cysts were found in 42 percent of fallopian tubes that were evaluated using the SEE-FIM (sectioning and extensively examining the fimbriated end) technique.² The cysts are usually less than a centimeter in size, and there is no consensus among pathologists on whether they require microscopic evaluation or mention in the report.³

In the majority of cases, there is no clinical indication for removing paratubal cysts as part of the sterilization procedure. The primary intent of the surgery is sterilization, and the diagnosis of a paratubal cyst does not influence how the patient is subsequently managed. Therefore, it would be unwise to artificially elevate the coding for sterilization samples by treating these incidental and clinically insignificant findings as a separate billable unit.

However, when a sterilization sample is submitted with a specific request by the surgeon to evaluate the paratubal cyst (for example, the specimen is labeled fallopian tube and cyst), an additional charge of 88304 level three for the cyst is reasonable.

1. CPT, RBRVS, RUC: a primer on the alphabet soup of coding and reimbursement. J Oncol Pract. 2007;3(1):20–22.
2. Sunde J, Wasickanin M, Katz TA, Wickersham EL, Steed DOE, Simper N. Prevalence of endosalpingiosis and other benign gynecologic lesions. PLoS One. 2020;15(5):e0232487.
3. Zheng R, Heller DS. A comprehensive review of paratubal lesions. Ann Diagn Pathol. 2022;57:151877.

Vinita Parkash, MBBS, MPH
Associate Professor of Pathology
Yale University School of Medicine
New Haven, Conn.
Vice Chair, CAP Surgical Pathology Committee