Summary & Overview
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.
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. |