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A simple vulvectomy, specifically a complete vulvectomy, involves the surgical removal of all structures of the vulva, which includes the mons pubis, labia majora and minora, clitoris, vaginal vestibule and glands, as well as the openings of the urethra and vagina. This procedure is typically indicated for the treatment of severe leukoplakia or confirmed malignancies of the vulva, such as extensive carcinoma in situ, microinvasive carcinoma, or Paget's disease. Unlike a radical vulvectomy, which extends into the perineal fascia, a simple vulvectomy is confined to the vulvar structures without deeper tissue involvement. The procedure is tailored to the specific location and extent of the disease, ensuring that excision margins are marked to include an adequate amount of healthy tissue surrounding the affected area. The surgical approach begins with an incision that is strategically placed to facilitate the complete removal of the vulvar structures while minimizing damage to surrounding tissues.
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The procedure of complete simple vulvectomy is indicated for the following conditions:
The complete simple vulvectomy procedure involves several critical steps to ensure thorough removal of the vulvar structures while maintaining patient safety. The procedure begins with the marking of excision margins, which is essential to include an adequate margin of healthy tissue surrounding the affected area. The incision is initiated above the labial folds in the mons pubis, extending down the lateral fold of the labia majora and across the posterior fourchette. As the procedure progresses, the pudendal arteries and veins are carefully clamped and tied bilaterally to control bleeding. Special attention is given to protect the urethral orifice, with the incision being extended from the meatus around the vaginal introitus. The rectum is also safeguarded as the incision is carried inferiorly. The last areas to be transected include the fat pad in the mons pubis and the vascular plexus surrounding the clitoris, which is clamped and tied prior to transection to manage any potential bleeding. After the complete excision of the vulvar structures, the surgical defect is repaired meticulously. This involves undermining and mobilizing the vaginal mucosa to prevent contracture of the introitus. Finally, a catheter is placed in the urethral meatus, and the periurethral mucosa is sutured to the skin to ensure proper healing and function.
Post-procedure care following a complete simple vulvectomy includes monitoring for any signs of complications such as excessive bleeding or infection. Patients may require pain management and should be advised on wound care to promote healing. Follow-up appointments are essential to assess the surgical site and ensure that recovery is progressing as expected. Additionally, patients may need guidance on activity restrictions during the recovery period to avoid strain on the surgical site.
| Short Descr | VULVECTOMY SIMPLE COMPLETE | Medium Descr | VULVECTOMY SIMPLE COMPLETE | Long Descr | Vulvectomy simple; complete | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 132 - Other OR therapeutic procedures, female organs |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | KX | Requirements specified in the medical policy have been met | LT | Left side (used to identify procedures performed on the left side of the body) |
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| 2025-01-01 | Changed | Short Description changed. |
| Pre-1990 | Added | Code added. |
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