2025 CPT code 56640
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Female Genital System Surgery Feed
Radical complete vulvectomy with inguinofemoral, iliac, and pelvic lymphadenectomy.
Modifiers may apply, for example, modifier 50 for bilateral procedures.
Medical necessity must be established by confirming the diagnosis of vulvar cancer or other qualifying condition and documenting the need for a radical vulvectomy with extensive lymphadenectomy. The medical record should clearly demonstrate that less radical procedures are inadequate.
The physician is responsible for the complete surgical removal of the vulva and the specified lymph nodes, ensuring adequate margins, managing bleeding, and reconstructing the surgical site.They also provide pre- and post-operative care.
In simple words: This is a surgery to remove all of the outer female genital tissue (vulva) and nearby lymph nodes in the groin, pelvis, and along the iliac vessels. This surgery is done to treat vulvar cancer.
This procedure involves the complete removal of the vulva, including the clitoris, labia majora and minora, and surrounding tissues, along with the inguinofemoral, iliac, and pelvic lymph nodes.It's typically performed to treat vulvar cancer. The procedure may include removal of deep fascia, portions of the lower abdomen adjacent to the vulva, and/or the perineal area.The surgeon may remove the entire area as a single piece (en bloc).A Foley catheter is placed. The patient is placed in a modified dorsal lithotomy position.The surgeon marks the excision area, makes incisions, and removes the lymph nodes and vulvar structures.The pudendal vessels are tied off, and bleeding is controlled.Vaginal packing may be placed. The defect can be closed with sutures or a skin graft. Drains may be placed in the groin.
Example 1: A 60-year-old female presents with stage III vulvar cancer. A radical complete vulvectomy with inguinofemoral, iliac, and pelvic lymphadenectomy (56640) is performed to remove the tumor and assess lymph node involvement., A patient with a large, invasive vulvar melanoma requires a radical complete vulvectomy with inguinofemoral, iliac, and pelvic lymphadenectomy (56640)., A 70-year-old female with recurrent vulvar carcinoma in situ undergoes a radical complete vulvectomy with inguinofemoral, iliac, and pelvic lymphadenectomy (56640) as a definitive treatment.
Documentation should include details about the size, location, and depth of the tumor, the extent of the vulvectomy, the number and location of lymph nodes removed, the method of reconstruction, and any complications.
** The harvesting and application of any skin grafts are coded separately.Be sure to document the removal of Cloquet's node, as its involvement has important staging implications.
- Specialties:Gynecologic Oncology, Obstetrics and Gynecology
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center