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The procedure described by CPT® Code 56637 refers to a radical vulvectomy, which is a surgical operation involving the complete removal of the vulva, including the external genital structures such as 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 extends deeper into the perineal fascia and may reach the periosteum of the pubic symphysis, ensuring that all cancerous tissues are excised. The surgical approach requires careful planning, including marking excision margins to include healthy tissue around the malignancy. The incision typically begins above the labial folds in the mons pubis and proceeds through various layers of tissue, ensuring that critical structures such as the urethra and rectum are protected throughout the procedure. Additionally, this code includes a bilateral inguinofemoral lymphadenectomy, which involves the removal of lymph nodes located in the groin area, further aiding in the treatment of cancer by addressing potential lymphatic spread. The complexity of this procedure necessitates a thorough understanding of the anatomy involved and the surgical techniques required to minimize complications and ensure effective treatment outcomes.
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The radical vulvectomy with bilateral inguinofemoral lymphadenectomy, as described by CPT® Code 56637, is indicated for the treatment of invasive carcinoma of the vulva. This procedure is typically performed when there is a confirmed diagnosis of malignancy that necessitates the complete removal of vulvar structures to ensure that all cancerous tissues are excised. The presence of invasive cancer is a critical factor that guides the decision to perform this extensive surgical intervention.
The procedure begins with the marking of excision margins to ensure that an adequate amount of healthy tissue is included in the surgical resection. 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 dissection progresses, the pudendal arteries and veins are clamped and tied bilaterally 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.
Post-procedure care following a radical vulvectomy with bilateral 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 promote healing. Follow-up appointments are essential to assess recovery and to monitor for any signs of recurrence of malignancy. Additionally, patients may need support for any psychological or emotional impacts resulting from the surgery, as the procedure significantly alters the anatomy of the vulvar region.
| Short Descr | VLVCTMY RAD COMP BI LYMPHAD | Medium Descr | VULVECTOMY RAD COMPL BI INGUINOFEM LYMPHADEC | Long Descr | Vulvectomy, radical, complete; 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) | 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. | 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. | 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.) | 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 |
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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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