What CPT (Current Procedural Terminology) code is used to report 50% removal of the vulva and deep subcutaneous tissues?

CPT Code for 50% Removal of the Vulva and Deep Subcutaneous Tissues

The correct CPT code for 50% removal of the vulva and deep subcutaneous tissues is 56625.

Understanding Vulvar Surgical Terminology and Coding

When determining the appropriate CPT code for vulvar procedures, it's essential to understand both the extent (percentage of vulva removed) and the depth of the procedure. According to the International Society for the Study of Vulvovaginal Disease (ISSVD) Surgical Oncological Procedure Definitions Committee, vulvar surgical procedures are defined by:

1. Extension: partial vs. total vulvectomy (removal of part vs. entire vulva)
2. Depth: superficial vs. deep (removal of superficial layer vs. removal to the urogenital diaphragm) 1

Analysis of CPT Code Options

Let's analyze each of the provided CPT codes:

• 56620: Simple partial vulvectomy
• 56625: Simple complete vulvectomy
• 56630: Radical partial vulvectomy
• 56633: Radical vulvectomy with inguinofemoral, iliac, and pelvic lymphadenectomy

Determining the Correct Code

The key factors in this case are:

• 50% of the vulva is being removed (partial vulvectomy)
• Deep subcutaneous tissues are included in the resection

When we examine the NCCN guidelines for vulvar cancer and surgical principles, we find that:

1. The depth of resection in vulvar procedures typically extends to the urogenital diaphragm 2
2. A "simple" vulvectomy refers to removal of the vulvar skin and subcutaneous tissues without lymph node dissection
3. A "radical" vulvectomy includes deeper tissues and would typically include lymph node evaluation 2

Since the question specifies:

• 50% removal (partial)
• Deep subcutaneous tissues (but no mention of lymph node dissection)

The procedure described is a simple complete vulvectomy, which is best represented by CPT code 56625.

Common Coding Pitfalls to Avoid

1. Misinterpreting "partial" vs. "complete": While only 50% of the vulva is being removed, in CPT terminology, this constitutes a "complete" vulvectomy when referring to the depth of the procedure rather than the horizontal extension.

2. Confusing "radical" with "deep": Radical procedures (56630,56633) specifically include lymphadenectomy, which is not mentioned in this scenario 2.

3. Overlooking depth specifications: The inclusion of "deep subcutaneous tissues" is a critical factor that distinguishes this from a simple partial vulvectomy (56620).

By understanding these distinctions in vulvar surgical procedures and their corresponding CPT codes, the appropriate code for 50% removal of the vulva with deep subcutaneous tissues is 56625.