How To Use CPT Code 56633

CPT 56633 describes a surgical procedure known as radical vulvectomy, which involves the removal of all or part of the vulva for the treatment of malignant disease. This article will cover the description, official details, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 56633?

CPT 56633 is a code used to describe a surgical procedure called radical vulvectomy. This procedure involves the removal of all or a significant portion of the vulva for the treatment of malignant diseases at various stages. The extent of the surgery may include the removal of lymph nodes and the clitoris, depending on the severity of the disease. It is important to note that adjacent tissue to the malignancy is also removed during this radical surgery.

2. Official Description

The official description of CPT code 56633 is: ‘Vulvectomy, radical, complete.’

3. Procedure

1. The patient is positioned in either the dorsal lithotomy position or the supine position, depending on the surgeon’s preference and the best access to the surgical site.
2. After administering general anesthesia, the surgeon marks the area to be excised and makes an incision along the marked line.
3. The surgeon removes all vulvar structures, including the skin, deep fascia, and muscle down to the bone, ensuring that adequate margins of non-cancerous tissue are removed.
4. If necessary, the surgeon may also remove the deep fascia of the thigh next to the vulva, part of the lower abdominal area adjacent to the vulva, and/or the perineal area below the vulva.
5. The pudendal vessels are securely tied, and bleeding is controlled using electrocautery.
6. Packing may be placed in the vagina if deemed necessary.
7. The defect is closed using layered suturing and/or a skin graft over the area.

4. Qualifying circumstances

CPT 56633 is performed for patients with malignant diseases of the vulva that require the removal of all or a significant portion of the vulva. The surgery may also involve the removal of lymph nodes and the clitoris, depending on the extent of the disease. It is important to note that adjacent tissue to the malignancy is also removed during this radical surgery.

5. When to use CPT code 56633

CPT code 56633 should be used when a radical vulvectomy is performed, involving the removal of all or a significant portion of the vulva for the treatment of malignant diseases. This code should be used for complete radical vulvectomy procedures where 80% or more of the vulva is removed.

6. Documentation requirements

To support a claim for CPT 56633, the following documentation is required:

• Documentation of the patient’s diagnosis and the need for a radical vulvectomy
• Details of the surgical procedure performed, including the extent of tissue removal and any additional procedures performed
• Date of the surgery and the duration of the procedure
• Any complications or unexpected findings during the surgery
• Details of the closure technique used
• Signature of the performing surgeon

7. Billing guidelines

When billing for CPT 56633, ensure that the procedure performed meets the criteria for a radical vulvectomy. It is important to accurately document the extent of tissue removal and any additional procedures performed. It is also essential to include any complications or unexpected findings during the surgery. CPT code 56633 should not be reported with other codes unless additional procedures, such as grafting, are performed. In such cases, the appropriate graft codes should be reported separately.

8. Historical information

CPT code 56633 was added to the Current Procedural Terminology system on January 1, 1993. The code underwent a change on January 1, 2010, with the addition of the term ‘complete’ to the official description. In 2017, it was added to the Inpatient Only (IPO) list for Medicare.

9. Examples

1. A patient undergoes a radical vulvectomy to remove a malignant tumor involving 90% of the vulva.
2. A surgeon performs a radical vulvectomy with removal of lymph nodes and the clitoris for a patient with advanced vulvar cancer.
3. A radical vulvectomy is performed on a patient with a large vulvar tumor that extends to adjacent tissue.
4. A patient with recurrent vulvar cancer undergoes a radical vulvectomy to remove all remaining cancerous tissue.
5. A radical vulvectomy is performed on a patient with a high-grade vulvar intraepithelial neoplasia (VIN) lesion.
6. A surgeon performs a radical vulvectomy on a patient with vulvar melanoma.
7. A patient with vulvar Paget’s disease undergoes a radical vulvectomy to remove the affected tissue.
8. A radical vulvectomy is performed on a patient with vulvar squamous cell carcinoma.
9. A patient with vulvar adenocarcinoma undergoes a radical vulvectomy to remove the cancerous tissue.
10. A surgeon performs a radical vulvectomy on a patient with vulvar sarcoma.