How To Use CPT Code 56634

CPT 56634 describes a surgical procedure known as radical vulvectomy with unilateral inguinofemoral lymphadenectomy. This article will provide an overview of the code, including its official description, the procedure involved, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples of when CPT 56634 may be used.

1. What is CPT Code 56634?

CPT 56634 is a code used to describe a surgical procedure called radical vulvectomy with unilateral inguinofemoral lymphadenectomy. This procedure involves the removal of all or part of the vulva for the treatment of malignant disease. It also includes the removal of the inguinofemoral lymph nodes on one side of the groin. Depending on the extent of the disease, the clitoris may also be removed. Tissue adjacent to the malignancy is also removed to ensure that an adequate margin of non-cancerous tissue is taken.

2. Official Description

The official description of CPT code 56634 is: ‘Vulvectomy, radical, complete; with unilateral inguinofemoral lymphadenectomy.’

3. Procedure

1. The patient is administered a general anesthetic and placed in a supine position.
2. An incision is made into the skin and through the subcutaneous layers in the right or left groin area.
3. The lymph nodes in the groin on the affected side are identified, isolated, and removed from surrounding tissues.
4. The incision is closed, and a drain may be left in place to remove excess fluid.
5. The patient may be changed from the supine to a modified dorsal lithotomy position.
6. The area to be excised is marked, and the physician makes an incision following the marked line.
7. All vulvar structures, including the skin, deep fascia, and muscle down to the bone, are removed.
8. The physician securely ties the pudendal vessels and controls bleeding with electrocautery.
9. Packing may be placed in the vagina, and the defect may be closed with layered sutures or a skin graft.

4. Qualifying circumstances

CPT 56634 is used for patients with malignant disease of the vulva that requires the removal of all or part of the vulva and the inguinofemoral lymph nodes on one side of the groin. The procedure may also involve the removal of adjacent tissue to ensure adequate margins of non-cancerous tissue. This surgery is typically performed by a qualified healthcare professional in a hospital or surgical center.

5. When to use CPT code 56634

CPT code 56634 should be used when a radical vulvectomy with unilateral inguinofemoral lymphadenectomy is performed. It is important to note that this code is specific to the complete removal of the vulva and lymph nodes on one side of the groin. If a different procedure or a bilateral lymphadenectomy is performed, a different CPT code should be used.

6. Documentation requirements

To support a claim for CPT code 56634, the healthcare professional must document the following information:

• Patient’s diagnosis and the need for radical vulvectomy
• Details of the procedure performed, including the extent of vulvar tissue and lymph nodes removed
• Date of the surgery
• Any additional procedures performed, such as the placement of a drain or packing
• Any complications or unexpected findings during the surgery
• Signature of the healthcare professional performing the procedure

7. Billing guidelines

When billing for CPT code 56634, ensure that the procedure performed matches the description of the code. It is important to accurately document the extent of the vulvectomy and lymphadenectomy. Additionally, any additional procedures performed, such as the placement of a drain or packing, should be documented and billed separately if applicable. It is also important to follow any specific billing guidelines provided by insurance companies or payers.

8. Historical information

CPT code 56634 was added to the Current Procedural Terminology system on January 1, 1993. The code has not undergone any updates since its addition. In 2017, it was added to the Inpatient Only (IPO) list for Medicare.

9. Examples

1. A patient with vulvar cancer undergoes a radical vulvectomy with unilateral inguinofemoral lymphadenectomy.
2. A healthcare professional performs a radical vulvectomy with unilateral inguinofemoral lymphadenectomy on a patient with advanced malignant disease of the vulva.
3. A surgical team performs a radical vulvectomy with unilateral inguinofemoral lymphadenectomy as part of the treatment for vulvar cancer.
4. A patient with a large vulvar tumor undergoes a radical vulvectomy with unilateral inguinofemoral lymphadenectomy to remove the cancerous tissue.
5. A healthcare professional performs a radical vulvectomy with unilateral inguinofemoral lymphadenectomy on a patient with recurrent vulvar cancer.
6. A patient with early-stage vulvar cancer undergoes a radical vulvectomy with unilateral inguinofemoral lymphadenectomy as the primary treatment.
7. A surgical team performs a radical vulvectomy with unilateral inguinofemoral lymphadenectomy on a patient with extensive malignant disease of the vulva.
8. A patient with vulvar intraepithelial neoplasia undergoes a radical vulvectomy with unilateral inguinofemoral lymphadenectomy to prevent the progression to invasive cancer.
9. A healthcare professional performs a radical vulvectomy with unilateral inguinofemoral lymphadenectomy on a patient with a large vulvar tumor that is causing significant symptoms.