Summary & Overview
CPT 58240: Pelvic Exenteration for Recurrent or Advanced Cervical Cancer
CPT code 58240 denotes pelvic exenteration, a major multi-organ surgical procedure most commonly used for recurrent cervical cancer after radiation or for advanced tumors involving both bladder and rectum. This code captures highly complex oncologic resections that may include removal of the uterus, adnexa, bladder, rectum, vagina, urethra, and portions of pelvic floor musculature. Pelvic exenteration represents one of the most resource-intensive gynecologic oncology operations and has significant implications for hospital resource use, post-operative care, and long-term survivorship and quality-of-life planning.
Key payers relevant to national reimbursement and coverage discussions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, an outline of typical sites of service and service type, and a guide to what the code represents for billing and administrative workflows. The publication also summarizes benchmarks, common modifier usage, and policy considerations that affect authorization, bundling, and inpatient payment practices. This material is written for national audiences involved in coding, billing, utilization management, and clinical program planning.
Billing Code Overview
CPT code 58240 describes a pelvic exenteration procedure performed for patients with recurrent cervical cancer after prior radiation therapy or for selected patients with stage IV disease involving both the bladder and rectum. The procedure is extensive and variable: in a total exenteration, the surgeon removes the uterus, fallopian tubes, ovaries, parametrial tissue, bladder, rectum, vagina, urethra, and portions of the levator ani muscles; anterior and posterior exenterations spare the rectum or bladder/urethra, respectively. Resection may also include portions of the anus, urethra, and vulva depending on tumor location and extent.
Service type: Major pelvic oncologic surgery / multi-organ resection
Typical site of service: Inpatient hospital setting (operative theatre with post-operative inpatient care)
Clinical & Coding Specifications
Clinical Context
A 58-year-old woman with a history of cervical squamous cell carcinoma previously treated with definitive pelvic radiotherapy presents with pelvic pain, recurrent vaginal bleeding, and fecal urgency. Imaging and cystoscopy confirm a locally recurrent tumor involving the central pelvis with extension into the urinary bladder and rectum. After multidisciplinary tumor board review and informed consent, the patient is scheduled for a total pelvic exenteration to achieve oncologic resection and palliation of symptoms. The perioperative workflow includes preoperative optimization (cardiopulmonary evaluation, nutritional assessment, stoma teaching), bowel and urinary diversion planning, intraoperative en bloc resection of involved organs (uterus, adnexa, bladder, rectum, vagina, distal urethra, portion of levator complex as indicated), creation of an end colostomy and urinary diversion (ileal conduit or continent diversion), intraoperative frozen sections as needed, and postoperative ICU or step-down monitoring with pain control, infection surveillance, stoma care, and coordination of adjuvant oncology follow-up.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when documented work, time, and complexity of the exenteration substantially exceed typical expectations. |
23 |