2025 CPT code 58240
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Female Genital System Surgery Feed
Pelvic exenteration for gynecologic malignancy, involving total abdominal hysterectomy or cervicectomy, with or without removal of tubes and/or ovaries, bladder removal and ureteral transplantation, and/or abdominoperineal resection of rectum and colon with colostomy, or any combination.
Modifiers may be applicable depending on the circumstances of the procedure.Consult the current CPT modifier guidelines for specific situations.
Pelvic exenteration is medically necessary for select patients with locally advanced or recurrent gynecologic malignancies that are not amenable to other treatment modalities.Medical necessity is determined based on the stage of the cancer, the extent of local involvement, and the patient's overall health status.The procedure may be considered curative or palliative, depending on the circumstances.
The surgeon performs the procedure, including making incisions, dissecting tissues, removing organs, performing ureteral transplantation and colostomy (if necessary), and closing the incisions. Anesthesia is administered by an anesthesiologist or certified registered nurse anesthetist (CRNA).A team of nurses and surgical technicians assist during the procedure. Post-operative care is managed by the surgical team, including physicians, nurses, and other healthcare professionals.
In simple words: Pelvic exenteration is major surgery to remove cancerous growths in the pelvis.This might include the uterus, cervix, vagina, bladder, and/or rectum.The surgeon removes these organs all at once, and depending on the cancer's location, the procedure may also involve creating an artificial opening for urine or stool to exit the body. This is a complex operation for serious cancer.
Pelvic exenteration is a radical surgical procedure performed for the treatment of advanced or recurrent gynecologic malignancies.The procedure involves en bloc resection of pelvic structures, potentially including the uterus, cervix, vagina, bladder, rectum, and surrounding tissues. The extent of the resection varies depending on the location and stage of the cancer.It may involve total abdominal hysterectomy or cervicectomy, removal of fallopian tubes and/or ovaries, bladder removal with ureteral transplantation, and/or abdominoperineal resection of the rectum and colon with creation of a colostomy.Post-operative care includes management of potential complications such as wound infection, urinary tract infections, and thromboembolic events. The specific organs and tissues removed are determined based on the location and stage of the cancer.Variations include total, anterior, and posterior exenterations.
Example 1: A 55-year-old female patient presents with recurrent cervical cancer after radiation therapy.A total pelvic exenteration is performed, removing the uterus, cervix, vagina, bladder, and rectum.Ureteral transplantation and colostomy are created., A 60-year-old female patient is diagnosed with stage IV vaginal cancer involving the bladder. An anterior pelvic exenteration is performed, removing the uterus, cervix, vagina, and bladder. Ureteral transplantation is performed. The rectum is preserved., A 48-year-old female patient presents with recurrent endometrial cancer involving the rectum. A posterior pelvic exenteration is performed, removing the uterus, cervix, vagina, and rectum. A colostomy is created. The bladder is preserved.
Complete medical history, including previous treatments and imaging studies (CT, MRI, PET scans). Preoperative consent form. Operative report detailing the extent of the resection, organs removed, reconstruction methods (ureteral transplantation, colostomy), and complications. Pathology report confirming the diagnosis and margins. Postoperative recovery notes, including complications and management.
** This is a complex and high-risk procedure with significant morbidity and mortality rates. Careful patient selection and counseling are crucial.The specific approach and extent of the surgery vary widely depending on the patient's condition and the surgeon's judgment.Postoperative care is intensive and includes pain management, bowel and bladder management, and monitoring for complications.
- Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
- RVU: Information not available in provided sources.RVUs vary based on geographic location and other factors. Consult a current fee schedule for precise values.
- Global Days: Information not available in provided sources.The global period will depend on payer and other factors. Consult local guidelines.
- Payment Status: Active
- Modifier TC rule: The TC modifier is not applicable to this code. This procedure is typically a global service encompassing pre-operative, intraoperative, and post-operative care.
- Fee Schedule: Historical fee schedule data is not available in provided sources.Consult a historical fee schedule database for the relevant information.
- Specialties:Gynecologic Oncology, Urology, Colorectal Surgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center