CPT 56631: Radical Vulvectomy with Unilateral Inguinofemoral Node Removal
CPT code 56631 represents a radical vulvectomy with removal of unilateral inguinofemoral lymph nodes performed to treat malignant disease of the vulva. This major gynecologic oncologic procedure can include partial or total vulvar excision and, when necessary, clitoral removal and excision of adjacent tissue to achieve clear margins. The code captures definitive surgical management for a spectrum of vulvar cancers and is relevant for surgical billing, inpatient resource use, and oncology care pathways nationwide.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a national overview of clinical context and service setting for CPT code 56631, plus benchmarking and policy-relevant topics commonly evaluated for major oncologic procedures: typical site-of-service patterns, expected service-level classification, and payer coverage considerations. The publication also outlines common modifiers and coding considerations when available, and highlights areas where additional documentation and coding specificity are often required for accurate payment and utilization tracking.
This summary provides clinicians, coders, and policy analysts with concise context on CPT code 56631, what it represents clinically, and the payer landscape relevant to institutional and outpatient surgical billing.
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Billing Code Overview
CPT code 56631 describes a radical vulvectomy with unilateral inguinofemoral lymph node dissection performed for malignant disease of the vulva. The procedure involves removal of all or part of the vulva, may include excision of the clitoris depending on disease extent, and includes resection of adjacent tissue to achieve oncologic margins.
Service type: Major gynecologic oncologic surgery
Typical site of service: Inpatient hospital surgical setting or ambulatory surgical center when clinically appropriate, depending on patient condition and extent of surgery. If extensive reconstruction or postoperative monitoring is required, an inpatient stay is typical.
Clinical & Coding Specifications
Clinical Context
A 64-year-old woman presents with a biopsy-confirmed invasive squamous cell carcinoma of the vulva with clinically positive ipsilateral inguinofemoral lymphadenopathy. After preoperative imaging and multidisciplinary evaluation, the gynecologic oncology surgeon schedules a 56631 radical vulvectomy with removal of unilateral inguinofemoral lymph nodes. The clinical workflow begins with preoperative counseling and medical optimization, anesthesia evaluation, and informed consent documenting extent of resection including possible clitoral excision and margins. Intraoperatively, radical excision of the vulvar tumor with planned wide margins is performed, followed by dissection and removal of the ipsilateral inguinofemoral nodal basin. Hemostasis, reconstructive closure (local flap or primary closure), and drain placement are completed as indicated. Postoperative care includes wound and drain management, pain control, DVT prophylaxis, pathology review of margins and nodes, coordination of adjuvant therapy if indicated, and documentation of estimated blood loss, procedure start/stop times, laterality, and any intraoperative complications.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier; standard reporting | Use when no additional modifier applies and the global service is reported as usual. |
22 | Increased procedural services | Use when work, time, and complexity substantially exceed normal for 56631 and documentation supports the increased work. |
23 | Unusual anesthesia | Use when surgery is performed under general anesthesia but the anesthesia record documents circumstances that normally would have required general anesthesia for minor procedures. |
26 | Professional component | Use when reporting only the professional (physician) component separate from technical services (rare for this operative code). |
50 | Bilateral procedure | Use if a bilateral radical vulvectomy and bilateral inguinofemoral lymphadenectomy were performed (note: 56631 describes unilateral removal; bilateral procedures must be supported clinically). |
51 | Multiple procedures | Use when 56631 is reported in addition to other distinct CPT surgical procedures performed during the same operative session. |
52 | Reduced services | Use when the procedure is intentionally partially performed or aborted and documentation supports a lesser service. |
53 | Discontinued procedure | Use when the procedure is started but terminated due to extenuating circumstances, with documentation of reason for discontinuation. |
62 | Two surgeons | Use when two surgeons work together as primary surgeons performing distinct surgical responsibilities during 56631. |
66 | Surgical team | Use when the procedure is performed by a surgical team where multiple surgeons are required for a portion of the operation. |
78 | Unplanned return to OR | Use when the patient returns to the operating room for a related procedure during the global period due to a complication. |
80 | Assistant surgeon | Use when an assistant surgeon participates and is entitled to an assistant surgeon fee. |
81 | Minimum assistant surgeon | Use when a minimum level assistant surgeon provides assistance. |
82 | Assistant surgeon (when qualified resident not available) | Use when an assistant surgeon is necessary because a qualified resident is not available. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207VG0100X | Gynecologic Oncology | Primary specialty that performs radical vulvectomy and inguinofemoral lymphadenectomy. |
207V00000X | Obstetrics & Gynecology | General gynecologic surgeons may perform vulvar cancer surgery in some settings. |
208800000X | Surgical Oncology | Surgical oncologists involved in complex oncologic resections and nodal dissections. |
208600000X | General Surgery | General surgeons may assist or perform groin/inguinal lymph node dissection in multidisciplinary cases. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
C51.9 | Malignant neoplasm of vulva, unspecified | Primary diagnosis indicating vulvar cancer requiring radical excision. |
C51.0 | Malignant neoplasm of labium majus | Site-specific vulvar malignancy that may require radical vulvectomy. |
C51.1 | Malignant neoplasm of labium minus | Site-specific vulvar malignancy potentially managed with radical surgery. |
C51.2 | Malignant neoplasm of clitoris | Involvement of the clitoris can necessitate more extensive resection including clitoridectomy as part of 56631. |
C79.2 | Secondary malignant neoplasm of skin | May be relevant if there are cutaneous metastases affecting surgical planning. |
Z85.41 | Personal history of malignant neoplasm of cervix | Relevant as part of oncologic history and planning for surveillance and management. |
D49.3 | Neoplasm of uncertain behavior of female genital organs | Considered when histology is uncertain and surgical excision is performed for diagnosis and treatment. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
19307 | Mastectomy, modified radical (includes removal of lymph nodes) | Provided as an example of an oncologic procedure with concurrent nodal dissection; not typically performed with 56631 but conceptually analogous for documentation of combined resection and nodal removal. |
38525 | Biopsy or excision of lymph node, open, superficial | May be used for diagnostic or limited nodal procedures when not performing a formal inguinofemoral lymphadenectomy. |
49020 | Excision of lesion of abdominal wall (subcutaneous) | Represents soft tissue excision coding; included to highlight coding for additional soft tissue resections or reconstructive components when performed concomitantly. |
15734 | Muscle, myocutaneous or fasciocutaneous flap with microvascular anastomosis (free flap) | Used when complex reconstruction is required after extensive vulvar resection. |
15738 | Muscle, myocutaneous or fasciocutaneous flap; trunk | Used for local flap reconstruction of vulvar defects when performed in same operative session. |