Summary & Overview
CPT 56634: Radical Vulvectomy with Unilateral Inguinofemoral Lymph Node Removal
CPT code 56634 denotes a radical vulvectomy, a major gynecologic oncology operation performed to remove all or part of the vulva for malignant disease and to excise unilateral inguinofemoral lymph nodes. As an extensive resective procedure often requiring inpatient surgical care, this code captures services with substantial clinical complexity and resource use. Nationally, accurate coding for radical vulvectomy affects surgical quality measurement, hospital reimbursement, and oncology care pathways.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and typical sites of service, plus what to expect in terms of documentation and coding considerations tied to major gynecologic oncologic surgery. The publication also summarizes benchmark metrics, common claim modifiers supplied in the input, and relevant policy considerations that frequently influence coverage and payment for extensive vulvar surgery.
This summary is intended for clinicians, coding professionals, and policy analysts seeking a national-level briefing on the clinical meaning and billing context of CPT code 56634, including the role the code plays in surgical oncology workflows and hospital billing lines. Data not available in the input are identified where applicable.
Billing Code Overview
CPT code 56634 represents a radical vulvectomy, a surgical procedure to remove all or part of the vulva to treat malignant disease. The operation includes unilateral removal of the inguinofemoral lymph nodes and may include removal of the clitoris depending on disease extent. As a radical oncologic procedure, tissue adjacent to the malignancy is removed to achieve clear margins.
Service Type: Major gynecologic oncologic surgery
Typical Site of Service: Inpatient hospital surgical setting
Clinical & Coding Specifications
Clinical Context
A 62-year-old female presents with a biopsy-confirmed squamous cell carcinoma of the vulva involving the left labia majora and extending toward the clitoral region. Preoperative workup includes pelvic examination, imaging (pelvic MRI or CT), and sentinel lymph node evaluation. The surgical plan is a radical vulvectomy with removal of the involved vulvar tissue including partial clitoral resection as indicated and unilateral inguinofemoral lymphadenectomy for staging and regional control. The procedure is performed in an operating room setting under general anesthesia with perioperative antibiotics and venous thromboembolism prophylaxis. Intraoperative steps include wide local excision of vulvar tumor with margins, dissection of adjacent soft tissue, unilateral inguinofemoral lymph node removal, hemostasis, possible wound drain placement, and layered closure or reconstructive flap if needed. Postoperative workflow includes recovery in PACU, inpatient monitoring for pain control and wound care, pathology review of surgical margins and lymph nodes, coordination with medical oncology and radiation oncology for adjuvant therapy based on final stage, and routine wound checks and surveillance visits.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required is substantially greater than typical for (e.g., extensive resection, complex reconstruction). |