Summary & Overview
CPT 57531: Radical Trachelectomy with Pelvic Lymphadenectomy
CPT code 57531 represents a radical trachelectomy with bilateral total pelvic lymph node dissection and para‑aortic lymph node biopsy, sometimes including oophorectomy. This code captures a major gynecologic oncologic surgical procedure used in management of cervical malignancies and select preinvasive conditions when fertility‑sparing approaches are not appropriate. Nationally, accurate use of this CPT code is important for procedural tracking, quality measurement, and payment integrity given the complexity and resource intensity of the service. Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise clinical context for the procedure, typical sites of service, and the common billing considerations associated with a radical trachelectomy and extensive lymphadenectomy. The publication also summarizes benchmarking and coverage themes, coding and documentation priorities relevant to hospitals and surgical practices, and policy developments that may affect reimbursement and utilization management. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 57531 describes a radical trachelectomy with bilateral total pelvic lymphadenectomy and biopsy of para-aortic lymph nodes. The procedure involves surgical removal of the uterine cervix (trachelectomy) and removal of bilateral pelvic lymph nodes; the surgeon may also remove the ovaries as part of the operation.
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Service Type: Major gynecologic oncologic surgery
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Typical Site of Service: Hospital operating room or ambulatory surgical center for complex oncologic procedures
Clinical & Coding Specifications
Clinical Context
A typical patient is a premenopausal or perimenopausal woman diagnosed with early-stage cervical cancer (e.g., IA2–IB1) who is a candidate for fertility-sparing surgery or for definitive surgical management when indicated. The patient presents with biopsy-proven cervical malignancy after colposcopy and directed biopsy; staging workup includes pelvic MRI and PET/CT to evaluate local extent and nodal status. The surgical workflow includes general anesthesia, radical trachelectomy with removal of the uterine cervix and parametrial tissues, bilateral total pelvic lymphadenectomy, and an intraoperative para-aortic lymph node biopsy (sampling). Ovarian conservation or oophorectomy is decided preoperatively based on age, tumor characteristics, and patient preference. Intraoperative frozen section pathology may be used to evaluate margins and lymph nodes; postoperative care includes pain control, infection prevention, monitoring for bleeding, and pathology review to determine need for adjuvant therapy. Typical sites of service are an acute care hospital operating room or an ambulatory surgical center when facility capabilities permit complex oncologic procedures under general anesthesia.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required is substantially greater than typical for the procedure (extensive adhesiolysis, unexpected complexity). |