The September Medi-Cal Update instructed Inpatient providers to use ICD-9-CM Volume 3 procedure codes instead of CPT-4 and/or HCPCS procedure codes effective for dates of service on or after September 22, 2003. This policy extends to sterilization and hysterectomy services.

A code correlation guide that lists sterilization and hysterectomy codes exclusively is provided below and an identical chart is provided in the Hysterectomy and Sterilization sections (Part 2), respectively, for reference.

Note: All providers other than Inpatient will continue using CPT-4 and/or HCPCS procedure codes.

Sterilization and hysterectomy services still require a signed consent form. Claims submitted with any of the following procedure codes that are not accompanied by the appropriate consent form will be denied.

Sterilization Services
Effective for dates of service on or after September 22, 2003, claims submitted by Inpatient providers for sterilization services require the following ICD-9-CM Volume 3 procedure codes:

CPT-4 or HCPCS Procedure Code	Description	ICD-9-CM Volume 3 Procedure Codes	Description
55250	Vasectomy, unilateral or bilateral	63.70 63.72 63.73	Male sterilization procedure, not otherwise specified Ligation of spermatic cord Vasectomy
55450	Ligation (percutaneous) of vas deferens, unilateral or bilateral	63.71	Ligation of vas deferens
58600	Ligation or transection of fallopian tube(s), abdominal or vaginal approach unilateral or bilateral	66.31 66.32 66.39 66.51 66.52 66.63	Other bilateral ligation and crushing of fallopian tubes Other bilateral ligation and division of fallopian tubes Other bilateral destruction or occlusion of fallopian tubes Removal of both fallopian tubes at same operative episode Removal of remaining fallopian tube Bilateral partial salpingectomy, not otherwise specified
58605	Ligation or transection of fallopian tube(s) abdominal or vaginal approach, postpartum, unilateral or bilateral, during the same hospitalization	66.31 66.32 66.39 66.51 66.52 66.63	Other bilateral ligation and crushing of fallopian tubes Other bilateral ligation and division of fallopian tubes Other bilateral destruction or occlusion of fallopian tubes Removal of both fallopian tubes at same operative episode Removal of remaining fallopian tube Bilateral partial salpingectomy, not otherwise specified
58611	Ligation or transection of fallopian tube(s) when done at the time of cesarean delivery or intra-abdominal surgery	66.31 66.32 66.39 66.51 66.52 66.63	Other bilateral ligation and crushing of fallopian tubes Other bilateral ligation and division of fallopian tubes Other bilateral destruction or occlusion of fallopian tubes Removal of both fallopian tubes at same operative episode Removal of remaining fallopian tube Bilateral partial salpingectomy, not otherwise specified
58615	Occlusion of fallopian tube(s) by device (eg band, clip, or Falope ring) vaginal or suprapubic approach	66.31 66.32 66.39 66.51 66.52 66.63	Other bilateral ligation and crushing of fallopian tubes Other bilateral ligation and division of fallopian tubes Other bilateral destruction or occlusion of fallopian tubes Removal of both fallopian tubes at same operative episode Removal of remaining fallopian tube Bilateral partial salpingectomy, not otherwise specified
58661	Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy)	66.21 66.22 66.29 66.31 66.32 66.39	Bilateral endoscopic ligation and crushing of fallopian tubes Bilateral endoscopic ligation and division of fallopian tubes Other bilateral endoscopic destruction or occlusion of fallopian tubes Other bilateral ligation and crushing of fallopian tubes Other bilateral ligation and division of fallopian tubes Other bilateral destruction or occlusion of fallopian tubes
58670	Laparoscopy, surgical with fulguration of oviducts (with or without transection)	66.21 66.22 66.29 66.31 66.32 66.39	Bilateral endoscopic ligation and crushing of fallopian tubes Bilateral endoscopic ligation and division of fallopian tubes Other bilateral endoscopic destruction or occlusion of fallopian tubes Other bilateral ligation and crushing of fallopian tubes Other bilateral ligation and division of fallopian tubes Other bilateral destruction or occlusion of fallopian tubes
58671	Laparoscopy; surgical with occlusion of oviducts by device (eg. band, clip, or Falope ring)	66.21 66.22 66.29 66.31 66.32 66.39	Bilateral endoscopic ligation and crushing of fallopian tubes Bilateral endoscopic ligation and division of fallopian tubes Other bilateral endoscopic destruction or occlusion of fallopian tubes Other bilateral ligation and crushing of fallopian tubes Other bilateral ligation and division of fallopian tubes Other bilateral destruction or occlusion of fallopian tubes
58700	Salpingectomy, complete or partial, unilateral or bilateral	66.21 66.22 66.29 66.31 66.32 66.39	Bilateral endoscopic ligation and crushing of fallopian tubes Bilateral endoscopic ligation and division of fallopian tubes Other bilateral endoscopic destruction or occlusion of fallopian tubes Other bilateral ligation and crushing of fallopian tubes Other bilateral ligation and division of fallopian tubes Other bilateral destruction or occlusion of fallopian tubes
Z1208	Minilaparotomy for female sterilization	66.31 66.32 66.39 66.51 66.52 66.63	Other bilateral ligation and crushing of fallopian tubes Other bilateral ligation and division of fallopian tubes Other bilateral destruction or occlusion of fallopian tubes Removal of both fallopian tubes at same operative episode Removal of remaining fallopian tube Bilateral partial salpingectomy, not otherwise specified
Z1210	Transection of fallopian tube, unilateral or bilateral with minilaparotomy, postpartum, during same hospitalization	66.31 66.32 66.39 66.51 66.52 66.63	Other bilateral ligation and crushing of fallopian tubes Other bilateral ligation and division of fallopian tubes Other bilateral destruction or occlusion of fallopian tubes Removal of both fallopian tubes at same operative episode Removal of remaining fallopian tube Bilateral partial salpingectomy, not otherwise specified

Hysterectomy Services

Effective for dates of service on or after September 22, 2003, claims submitted by Inpatient providers for hysterectomy services require the following ICD-9-CM Volume 3 procedure codes:

CPT-4 Code	Description	ICD-9-CM Volume 3 Procedure Codes	Description
51597	Pelvic exenteration, complete, for vesical, prostatic or urethral malignancy, with removal of bladder and ureteral transplantations, with or without hysterectomy	68.8	Pelvic evisceration
51925	Closure of vesicouterine fistula; with hysterectomy	68.3 68.4	Subtotal abdominal hysterectomy Total abdominal hysterectomy
58150	Total abdominal hysterectomy with or without removal of ovary	68.4	Total abdominal hysterectomy
58152	Total abdominal hysterectomy with colpo-urethrocystopexy	68.4	Total abdominal hysterectomy
58180	Supracervical abdominal hysterectomy (subtotal hysterectomy) with or without removal or tube(s)	68.3	Subtotal abdominal hysterectomy
58200	Total abdominal hysterectomy, including partial vaginectomy	68.6	Radical abdominal hysterectomy
58210	Radical abdominal hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling	68.6	Radical abdominal hysterectomy
58240	Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy	68.8	Pelvic evisceration
58260	Vaginal hysterectomy, for uterus 250 grams or less	68.51 68.59	Laparoscopically assisted vaginal hysterectomy Other vaginal hysterectomy
58262	Vaginal hysterectomy with removal of tube(s) and or ovary(s)	68.51 68.59	Laparoscopically assisted vaginal hysterectomy Other vaginal hysterectomy
58263	Vaginal hysterectomy with removal of tube(s) and/or ovary(s), with repair of enterocele	68.51 68.59	Laparoscopically assisted vaginal hysterectomy Other vaginal hysterectomy
58267	Vaginal hysterectomy with colpo-urethocystopexy	68.51 68.59	Laparoscopically assisted vaginal hysterectomy Other vaginal hysterectomy
58270	Vaginal hysterectomy with repair of enterocele	68.51 68.59	Laparoscopically assisted vaginal hysterectomy Other vaginal hysterectomy
58275	Vaginal hysterectomy, with total or partial vaginectomy	68.51 68.59	Laparoscopically assisted vaginal hysterectomy Other vaginal hysterectomy
58280	Vaginal hysterectomy, with repair of enterocele	68.51 68.59	Laparoscopically assisted vaginal hysterectomy Other vaginal hysterectomy
58285	Vaginal hysterectomy, radical	68.7	Radical vaginal hysterectomy
58290	Vaginal hysterectomy, for uterus greater than 250 grams	68.51 68.59	Laparoscopically assisted vaginal hysterectomy Other vaginal hysterectomy
58291	Vaginal hysterectomy with removal of tube(s) and/or ovary(s)	68.51 68.59	Laparoscopically assisted vaginal hysterectomy Other vaginal hysterectomy
58292	Vaginal hysterectomy with removal of tube(s) and/or ovary(s), with repair of enterocele	68.51 68.59	Laparoscopically assisted vaginal hysterectomy Other vaginal hysterectomy
58293	Vaginal hysterectomy with colpo-urethrocystopexy with or without endoscopic control	68.51 68.59	Laparoscopically assisted vaginal hysterectomy Other vaginal hysterectomy
58294	Vaginal hysterectomy with repair of enterocele	68.51 68.59	Laparoscopically assisted vaginal hysterectomy Other vaginal hysterectomy
58550	Laparoscopy surgical, with vaginal hysterectomy, for uterus 250 grams or less	68.51	Laparoscopically assisted vaginal hysterectomy
58552	Laparoscopy surgical with removal of tube(s) and/or ovary(s)	68.51	Laparoscopically assisted vaginal hysterectomy
58553	Laparoscopy surgical, with vaginal hysterectomy, for uterus greater than 250 grams	68.51	Laparoscopically assisted vaginal hysterectomy
58554	Laparoscopy surgical with removal of tube(s) and/or ovary(s)	68.51	Laparoscopically assisted vaginal hysterectomy
58951	Resection of ovarian with total abdominal hysterectomy	68.4	Total abdominal hysterectomy
59135	Surgical treatment of ectopic pregnancy; tubal or ovarian interstitial, uterine pregnancy requiring total hysterectomy	68.4	Total abdominal hysterectomy

For Medical Services (MS), Clinics and Hospitals (CAH) and Inpatient Services (IPS), this information is reflected on manual replacement pages hyst 2 thru 6 (Part 2) and ster 22 thru 31 (Part 2).