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Pelvic exenteration is a complex surgical procedure primarily aimed at treating malignancies located in the bladder, prostate, or urethra that have metastasized to adjacent pelvic tissues or organs. This extensive operation involves the complete removal of the bladder and may also include the excision of reproductive organs, such as the uterus, ovaries, fallopian tubes, and cervix in females, or the prostate in males, depending on the extent of the cancer and previous surgical interventions. The procedure is characterized by its comprehensive approach to addressing cancer that has spread beyond its original site, necessitating the removal of not only the affected organs but also surrounding tissues that may harbor cancerous cells. During the surgery, the abdomen is opened to allow for thorough exploration of the pelvic cavity, including inspection of the liver, peritoneum, bowel, and lymph nodes. Biopsies may be taken to assess the extent of the disease. The surgical team carefully dissects and removes the involved organs while ensuring that any necessary urinary diversion is established, which may involve the transplantation of ureters. The procedure may also include the creation of a colostomy if the rectum and colon are resected. The reconstruction of the pelvic area is an essential component of the surgery, utilizing various techniques such as omental, myocutaneous, or muscle flaps to restore the anatomy and function of the pelvis post-exenteration. Overall, pelvic exenteration is a significant intervention that requires careful planning and execution to manage the complexities associated with advanced malignancies in the pelvic region.
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The pelvic exenteration procedure is indicated for patients diagnosed with malignancies affecting the bladder, prostate, or urethra that have metastasized to surrounding pelvic structures. The specific indications for this procedure include:
The pelvic exenteration procedure involves several critical steps, each designed to ensure the complete removal of cancerous tissues while preserving as much surrounding healthy tissue as possible. The procedural steps include:
Post-procedure care following pelvic exenteration is critical for patient recovery and involves several considerations. Patients will typically require close monitoring in a postoperative setting to manage pain and prevent complications. The expected recovery period may vary based on the extent of the surgery and the patient's overall health. Patients may need to adapt to changes in urinary and bowel function due to the removal of the bladder and potential colostomy. Follow-up appointments are essential for monitoring healing, managing any complications, and assessing the need for additional treatments, such as chemotherapy or radiation, depending on the pathology results. Education on self-care, including stoma care if applicable, is also an important aspect of post-operative management to ensure a smooth recovery process.
| Short Descr | REMOVAL OF PELVIC STRUCTURES | Medium Descr | PELVIC EXENTERATION COMPLETE MALIGNANCY | Long Descr | Pelvic exenteration, complete, for vesical, prostatic or urethral malignancy, with removal of bladder and ureteral transplantations, with or without hysterectomy and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 112 - Other OR therapeutic procedures of urinary tract |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CR | Catastrophe/disaster related | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study |
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| Pre-1990 | Added | Code added. |
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