2025 CPT code 56634
Effective Date: N/A Surgery - Surgical Procedures on the Female Genital System Feed
Radical complete vulvectomy with unilateral inguinofemoral lymphadenectomy.
Modifiers may be applicable in certain situations, such as increased procedural services (22), multiple procedures (51), or assistant surgeon (80).
Medical necessity is established by the presence of vulvar cancer requiring surgical resection. The extent of the procedure (radical vs. simple, partial vs. complete) is determined by the size and stage of the cancer and the involvement of surrounding tissues and lymph nodes.
The physician performs a complete radical vulvectomy with unilateral inguinofemoral lymphadenectomy, which may include removing deep fascia of the thigh, lower abdominal area adjacent to the vulva, and/or the perineal area. The procedure starts with lymph node removal in the supine position, followed by vulvectomy, often in a modified dorsal lithotomy position. The vulvar structures are removed down to the bone, bleeding is controlled, and the defect may be closed with sutures or a skin graft.
In simple words: This surgery removes all of the external female genital tissue and some of the surrounding tissue, as well as lymph nodes in one groin, to treat vulvar cancer.
This procedure involves the removal of the entire vulva (including the clitoris, labia majora and minora, and mons pubis) along with deep subcutaneous tissues and unilateral inguinofemoral lymph nodes. It is typically performed for the treatment of advanced vulvar malignancies.
Example 1: A 60-year-old female presents with a 3 cm squamous cell carcinoma of the left labia majora with clinically positive left inguinal lymph nodes. A radical complete vulvectomy with left inguinofemoral lymphadenectomy is performed., A 75-year-old female is diagnosed with a 2 cm melanoma of the clitoris with palpable right inguinal lymph nodes. A complete radical vulvectomy with right inguinofemoral lymphadenectomy is performed, including a split-thickness skin graft to close the surgical defect., A 55-year-old female with a history of vulvar intraepithelial neoplasia (VIN) now has a multifocal invasive vulvar cancer involving more than 80% of the vulva. She undergoes a complete radical vulvectomy with left inguinofemoral lymphadenectomy.
Documentation should include the size, location, and depth of the tumor, the extent of vulvar involvement, the presence or absence of clinically positive lymph nodes, the type of closure (primary vs. skin graft), and any intraoperative complications.
** This code represents a unilateral lymphadenectomy. If a bilateral lymphadenectomy is performed, code 56637 should be used.
- Specialties:Gynecologic Oncology
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center