How To Use CPT Code 58240

CPT 58240 describes the surgical procedure known as pelvic exenteration for gynecologic malignancy. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 58240?

CPT 58240 is a code used to describe the surgical procedure called pelvic exenteration for gynecologic malignancy. This procedure is performed on patients who have had a recurrence of cancer of the cervix after radiation therapy or patients with stage IV cancer where the tumor is located in the bladder and rectum. The specific organs and tissues that are removed during the procedure depend on the location and stage of the cancer.

2. Official Description

The official description of CPT code 58240 is: ‘Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof.’

3. Procedure

1. The patient is placed in the supine position and given general anesthesia.
2. An abdominal incision is made to access the peritoneal cavity.
3. Any adhesions of the small bowel and colon from prior radiation treatments are lysed.
4. The provider explores the abdominal and pelvic cavity for the presence of tumors and packs the bowel into the upper abdomen.
5. The bladder and rectum are freed from the vaginal walls, and any adhesions around the ureters are removed.
6. If the patient still has a uterus, the connections holding the uterus and cervix in place are severed, and the uterus, fallopian tubes, ovaries, cervix, upper part of the vagina, and surrounding parametrial tissue are removed.
7. The colon and bladder are freed within their space, and the bladder is removed.
8. If there is any cancer in the perineum area, the involved part of the vulva is also removed.
9. A section of the ileum is taken, and the ureters are implanted into this section, with stents placed to keep them open and draining urine.
10. A hole is created in the abdomen for the ileum to be opened to the outside of the body, allowing urine to drain away.
11. An end-to-end colostomy is performed by incising the sigmoid colon, sewing the lower end together, and inserting the upper end through an incision in the abdomen to form a colostomy for feces removal.
12. Drains are placed in the abdominal cavity, and the abdominal incisions are closed in layers.

4. Qualifying circumstances

CPT 58240 is performed on patients who have had a recurrence of cancer of the cervix after radiation therapy or patients with stage IV cancer where the tumor is located in the bladder and rectum. The specific organs and tissues that are removed depend on the location and stage of the cancer. The procedure is typically performed by a gynecologic oncologist or a surgeon with expertise in pelvic surgery.

5. When to use CPT code 58240

CPT code 58240 should be used when performing a pelvic exenteration procedure for gynecologic malignancy. It is important to accurately document the specific organs and tissues removed during the procedure, as well as the location and stage of the cancer. This code should not be used for pelvic exenteration procedures performed for lower urinary tract or male genital malignancy, as a different code (51597) should be used in those cases.

6. Documentation requirements

To support a claim for CPT code 58240, the following documentation is required:

• Patient’s diagnosis of gynecologic malignancy and the need for pelvic exenteration
• Specific organs and tissues removed during the procedure
• Location and stage of the cancer
• Date of the procedure
• Details of the surgical technique used
• Any complications or unexpected findings during the procedure
• Signature of the performing surgeon

7. Billing guidelines

When billing for CPT code 58240, ensure that the procedure meets the criteria for pelvic exenteration for gynecologic malignancy. It is important to accurately document the specific organs and tissues removed, as well as the location and stage of the cancer. CPT code 58240 should not be reported for pelvic exenteration procedures performed for lower urinary tract or male genital malignancy, as a different code (51597) should be used in those cases. It is also important to follow any additional billing guidelines provided by the payer.

8. Historical information

CPT code 58240 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 billing purposes.

9. Examples

1. A gynecologic oncologist performing a pelvic exenteration procedure for a patient with recurrent cervical cancer.
2. A surgeon performing a pelvic exenteration procedure for a patient with stage IV ovarian cancer involving the bladder and rectum.
3. A gynecologic oncologist performing a pelvic exenteration procedure for a patient with endometrial cancer that has spread to the bladder and rectum.
4. A surgeon performing a pelvic exenteration procedure for a patient with vulvar cancer involving the bladder and rectum.