How To Use CPT Code 56640

CPT 56640 describes the surgical procedure known as radical vulvectomy, which involves the complete removal of all or part of the vulva for the treatment of malignant disease. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 56640?

CPT 56640 is a code used to describe the surgical procedure known as radical vulvectomy. This procedure involves the complete removal of all or a significant portion of the vulva for the treatment of malignant disease. It may also include the removal of inguinofemoral, iliac, and pelvic lymph nodes, depending on the extent of the disease. The provider may also remove the clitoris if necessary. The purpose of this surgery is to remove the cancerous tissue and ensure that adequate margins of non-cancerous tissue have been excised.

2. Official Description

The official description of CPT code 56640 is: ‘Vulvectomy, radical, complete, with inguinofemoral, iliac, and pelvic lymphadenectomy.’ It is important to note that if the procedure is performed bilaterally, modifier 50 should be appended to the code.

3. Procedure

1. The patient is administered a general anesthetic and placed in a modified dorsal lithotomy position.
2. The surgeon marks the area to be excised, which typically resembles the shape of a rabbit’s head, with the ears representing the groin area or the lymph nodes.
3. An incision is made into the skin and through all of the subcutaneous layers to the deep fascia, following the marked line.
4. The lymph nodes in the inguinofemoral, iliac, and pelvic regions are identified and isolated, and then removed from the surrounding tissues.
5. All vulvar structures, including the mons, clitoris, labia minor, and labia majora, are excised, along with the skin, deep fascia, and muscle down to the bone.
6. The pudendal vessels are securely tied, and bleeding is controlled using electrocautery.
7. If necessary, packing may be placed in the vagina.
8. The defect may be closed with layered sutures or a skin graft, and drains may be left in place in the groin area to remove excess fluid.

4. Qualifying circumstances

CPT 56640 is used for patients with malignant disease of the vulva that requires the complete removal of all or a significant portion of the vulva. The procedure may also involve the removal of inguinofemoral, iliac, and pelvic lymph nodes. It is important to note that if the procedure is performed bilaterally, modifier 50 should be appended to the code.

5. When to use CPT code 56640

CPT code 56640 should be used when a radical vulvectomy is performed, involving the complete removal of all or a significant portion of the vulva for the treatment of malignant disease. It is important to ensure that the procedure meets the criteria outlined in the official description and that the appropriate documentation is provided.

6. Documentation requirements

To support a claim for CPT code 56640, the following documentation is required:

• Documentation of the patient’s diagnosis and the need for a radical vulvectomy
• Details of the procedure performed, including the extent of vulvar tissue and structures removed, as well as the lymph nodes excised
• Date of the procedure
• Any additional procedures performed, such as the placement of packing or the use of drains
• Signature of the performing physician

7. Billing guidelines

When billing for CPT code 56640, it is important to ensure that the procedure meets the criteria outlined in the official description. If the procedure is performed bilaterally, modifier 50 should be appended to the code. It is also important to follow any additional billing guidelines provided by the payer.

8. Historical information

CPT code 56640 was added to the Current Procedural Terminology system on January 1, 1990. In 2017, it was added to the Inpatient Only (IPO) list for Medicare.

9. Examples

1. A patient undergoes a radical vulvectomy with inguinofemoral, iliac, and pelvic lymphadenectomy for the treatment of vulvar cancer.
2. A surgeon performs a radical vulvectomy with bilateral inguinofemoral lymphadenectomy for a patient with advanced malignant disease of the vulva.
3. A patient with recurrent vulvar cancer undergoes a radical vulvectomy with unilateral inguinofemoral and pelvic lymphadenectomy.
4. A radical vulvectomy with bilateral inguinofemoral, iliac, and pelvic lymphadenectomy, including external iliac artery lymphadenectomy, is performed for a patient with extensive vulvar cancer.
5. A surgeon performs a radical vulvectomy with unilateral inguinofemoral and pelvic lymphadenectomy for a patient with early-stage vulvar cancer.
6. A patient undergoes a radical vulvectomy with bilateral inguinofemoral and pelvic lymphadenectomy for the treatment of recurrent vulvar cancer.
7. A radical vulvectomy with unilateral inguinofemoral lymphadenectomy is performed for a patient with localized vulvar cancer.
8. A patient with vulvar cancer undergoes a radical vulvectomy with bilateral inguinofemoral, iliac, and pelvic lymphadenectomy, including external iliac artery lymphadenectomy.