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The procedure described by CPT® Code 56633 refers to a radical complete vulvectomy, which involves the surgical removal of the entire vulva, including the mons pubis, labia majora and minora, clitoris, vaginal vestibule, glands, urethral opening, and vaginal opening. This extensive procedure is primarily indicated for the treatment of invasive carcinoma affecting the vulvar region. Unlike a simple vulvectomy, which only removes a portion of the vulva, a radical vulvectomy extends deeper into the perineal fascia and may even reach the periosteum of the pubic symphysis, ensuring that all affected vulvar structures are excised. The surgical approach requires careful marking of excision margins to include a sufficient amount of healthy tissue surrounding the malignancy. The incision typically begins above the labial folds in the mons pubis and proceeds through various layers of tissue, including the skin and subcutaneous fat, down to the perineal fascia. The procedure is designed to ensure complete removal of cancerous tissues while minimizing the risk of complications and promoting optimal healing.
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The radical complete vulvectomy (CPT® Code 56633) is indicated for the treatment of invasive carcinoma of the vulva. This procedure is typically performed when malignancies require extensive excision of vulvar structures to ensure complete removal of cancerous tissues.
The radical vulvectomy procedure involves several critical steps to ensure complete excision of the vulvar tissues. The first step involves marking the excision margins to include an adequate amount of healthy tissue surrounding the malignancy. The incision is initiated above the labial folds in the mons pubis, where the skin is incised down to the level of subcutaneous fat. Deep dissection continues through the layers until reaching the perineal fascia, and if necessary, extending into the periosteum of the pubic symphysis. The incision is then extended down the lateral fold of the labia majora and across the posterior fourchette. As the procedure progresses, the pudendal arteries and veins are clamped and tied bilaterally upon encountering them. Care is taken to protect the urethral orifice while extending the incision from the meatus around the vaginal introitus. The rectum is also protected as the incision is carried inferiorly. The final 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 control any bleeding. After the surgical defect is created, the repair involves undermining and mobilizing the vaginal mucosa to prevent contracture of the introitus. A catheter is placed in the urethral meatus, and the periurethral mucosa is sutured to the skin to complete the procedure.
Post-procedure care following a radical vulvectomy includes monitoring for complications such as bleeding, infection, and proper healing of the surgical site. Patients may require pain management and should be advised on wound care to promote healing. Follow-up appointments are essential to assess recovery and to monitor for any signs of recurrence of malignancy. Additionally, if inguinofemoral lymphadenectomy is performed, patients may need specific care instructions related to lymphatic drainage and potential swelling in the groin area.
| Short Descr | VULVECTOMY RADICAL COMPLETE | Medium Descr | VULVECTOMY RADICAL COMPLETE | Long Descr | Vulvectomy, radical, 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) | 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) |
| 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. | 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. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 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 | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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. |
| 2010-01-01 | Changed | Code description changed. |
| 1993-01-01 | Added | First appearance in code book in 1993. |
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