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The procedure described by CPT® Code 56634 refers to a radical vulvectomy, which is a surgical operation involving the complete removal of the vulva, including the mons pubis, labia majora and minora, clitoris, vaginal vestibule, 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 involves the removal of less tissue, a radical vulvectomy entails excising not only the vulvar structures but also extending the incision into the perineal fascia and potentially reaching the periosteum of the pubic symphysis. The surgical approach requires careful planning to ensure that excision margins are adequate, incorporating healthy tissue around the tumor to minimize the risk of residual cancerous cells. 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, with deep dissection to ensure complete removal of affected areas. Additionally, this procedure is often accompanied by a unilateral inguinofemoral lymphadenectomy, which involves the removal of lymph nodes in the groin area to assess and manage potential metastasis. The combination of these surgical interventions is critical in the comprehensive treatment of vulvar cancer, aiming to achieve clear margins and prevent the spread of malignancy.
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The radical vulvectomy with unilateral inguinofemoral lymphadenectomy, as described by CPT® Code 56634, is indicated for the treatment of invasive carcinoma of the vulva. This procedure is typically performed when there is a confirmed diagnosis of vulvar cancer that necessitates the removal of all vulvar structures to ensure complete excision of malignant tissue. The presence of invasive malignancy is a critical factor that guides the decision to perform this extensive surgical intervention.
The procedure for a radical vulvectomy with unilateral inguinofemoral lymphadenectomy involves several detailed steps to ensure complete removal of the vulvar structures and associated lymph nodes. The surgical process begins with marking the excision margins to include an adequate amount of healthy tissue surrounding the tumor. 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 is then performed, continuing down to the perineal fascia and potentially into the periosteum of the pubic symphysis if necessary. The incision is extended along the lateral fold of the labia majora and across the posterior fourchette. During this dissection, the pudendal arteries and veins are clamped and tied bilaterally as they are encountered to control bleeding. Care is taken to protect the urethral orifice while extending the incision from the meatus around the vaginal introitus. The rectum is also safeguarded 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 manage hemorrhage effectively. After the radical vulvectomy is completed, the surgical defect is repaired, ensuring that the vaginal mucosa is undermined and mobilized to prevent contracture of the introitus. A catheter is placed in the urethral meatus, and the periurethral mucosa is sutured to the skin to secure the area. Following the vulvectomy, if unilateral inguinofemoral lymphadenectomy is indicated, a skin incision is made just below and parallel to the groin crease. This incision is carried through the membranes covering the inguinal vein and artery to expose the inguinofemoral lymph nodes, which are then excised. If a bilateral lymphadenectomy is required, the procedure is repeated on the contralateral side.
Post-procedure care following a radical vulvectomy with unilateral inguinofemoral lymphadenectomy involves monitoring for complications such as infection, bleeding, and proper healing of the surgical site. Patients may require pain management and should be advised on wound care to maintain hygiene and prevent infection. Follow-up appointments are essential to assess recovery and to monitor for any signs of recurrence of malignancy. Additionally, patients may need support for emotional and psychological impacts related to the surgery and its effects on their body image and sexual function. Rehabilitation services may also be beneficial to aid in recovery and adaptation following the procedure.
| Short Descr | VLVCTMY RAD COMP UNI LYMPHAD | Medium Descr | VULVECTOMY RAD COMPL UNI INGUINOFEM LYMPHADEC | Long Descr | Vulvectomy, radical, complete; with unilateral 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) | 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) |
| 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. | 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 | RT | Right side (used to identify procedures performed on the right side of the body) |
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| 2025-01-01 | Changed | Short and Medium Descriptions changed. |
| 2013-01-01 | Changed | Medium Descriptor changed. |
| 1993-01-01 | Added | First appearance in code book in 1993. |
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