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The procedure described by CPT® Code 56632 refers to a radical partial vulvectomy combined with bilateral inguinofemoral lymphadenectomy. The vulva encompasses various structures of the external female genitalia, including the mons pubis, labia majora and minora, clitoris, vaginal vestibule, glands, urethral opening, and vaginal opening. A radical vulvectomy is a surgical intervention typically indicated for the treatment of invasive carcinoma affecting the vulva. This procedure is distinct from a simple vulvectomy, as it involves a more extensive excision that penetrates into the perineal fascia. In the context of CPT® Codes 56630 to 56632, the malignancy is localized to a portion of the vulva, necessitating the removal of only the affected area while ensuring that adequate margins of healthy tissue are preserved. The surgical approach involves careful marking of excision margins, followed by an incision through the skin down to the subcutaneous fat, with deep dissection extending to the perineal fascia and potentially into the periosteum of the pubic symphysis, depending on the extent of the disease. The excised tissue may include various structures based on the specific location of the malignancy, such as portions of the labia, vaginal vestibule, and associated glands. The procedure may also involve the removal of inguinofemoral lymph nodes, which is performed based on the presence and location of cancer, with bilateral lymphadenectomy indicated when the malignancy is centrally located. This comprehensive surgical approach aims to effectively manage the disease while minimizing the risk of recurrence.
© Copyright 2025 Coding Ahead. All rights reserved.
The radical partial vulvectomy with bilateral inguinofemoral lymphadenectomy, as described by CPT® Code 56632, is indicated for the treatment of invasive carcinoma of the vulva. The procedure is specifically performed when the malignancy is localized to a portion of the vulva, necessitating the removal of the affected area along with an adequate margin of healthy tissue. The presence of cancer in the middle of the vulva typically warrants a bilateral lymphadenectomy, while unilateral lymphadenectomy may be performed if the malignancy is confined to one side.
The procedure begins with the careful marking of excision margins to ensure that an adequate amount of healthy tissue is included in the resection. The surgeon makes a skin incision down to the level of the subcutaneous fat, ensuring that the incision is deep enough to allow for thorough dissection. The dissection continues down to the perineal fascia, and if necessary, into the periosteum of the pubic symphysis, depending on the extent of the malignancy. The specific structures excised during the partial vulvectomy may vary based on the location of the cancer. For instance, if the malignancy is on the right side, the excised tissue may include the right labia majora and minora, vaginal vestibule, and associated glands. Alternatively, if the cancer is located in the upper portion of the vulva, the excised structures may include the mons pubis, upper labia, clitoris, and upper aspect of the vaginal vestibule. In cases where the malignancy is in the lower portion, the excised tissue may consist of the lower labia and lower aspect of the vaginal vestibule. Following the excision of the vulvar tissue, the procedure proceeds with the inguinofemoral lymphadenectomy. A skin incision is made just below and parallel to the groin crease, allowing access to the inguinal region. The incision is carried through the membranes covering the inguinal vein and artery to expose the inguinofemoral lymph nodes, which are then carefully removed. If a bilateral lymphadenectomy is indicated, the procedure is repeated on the contralateral side. After the lymphadenectomy is completed, the surgeon continues with the radical partial vulvectomy, ensuring that all affected tissues are adequately excised.
Post-procedure care following a radical partial vulvectomy with bilateral inguinofemoral lymphadenectomy includes monitoring for complications such as infection, bleeding, and wound healing issues. Patients may experience pain and discomfort in the surgical area, which can be managed with appropriate analgesics. It is essential for patients to follow up with their healthcare provider for regular assessments and to monitor for any signs of recurrence or complications related to the surgery. Recovery time may vary based on the extent of the surgery and the individual patient's health status, but patients are generally advised to avoid strenuous activities and heavy lifting during the initial recovery period. Additionally, patients may require education on self-care practices and signs of complications to ensure a smooth recovery process.
| Short Descr | VLVCTMY RAD PRTL BI LYMPHAD | Medium Descr | VULVECTOMY RAD PRTL BI INGUINOFEM LMPHADECTOMY | Long Descr | Vulvectomy, radical, partial; with bilateral inguinofemoral lymphadenectomy | 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) | 2 - 150% payment adjustment 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) | 2 - Co-surgeons permitted and no documentation required if the two- specialty requirement is met. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | 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 |
This is a primary code that can be used with these additional add-on codes.
| 38900 | Addon Code MPFS Status: Active Code APC N ASC N1 Intraoperative identification (eg, mapping) of sentinel lymph node(s) includes injection of non-radioactive dye, when performed (List separately in addition to code for primary procedure) |
| 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). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 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. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 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 | PD | Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days |
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| 2025-01-01 | Changed | Short Description changed. |
| 2013-01-01 | Changed | Medium Descriptor changed. |
| 1994-01-01 | Added | First appearance in code book in 1994. |
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