As for my openion, Closure definitely have to be reported separately, and codes depend upon the areas and layers involved.
Vulvectomy especially radical, is very extensive, most often a life time procudure and difficult procedure - and very extensive complex closure involving-closure of perineum,
labial margins on bothsides, vagina, posterior forchette, Inguinal area and lowen abdomenal incision and mobilized tissues closure.
For eg)Closure radical (with lymphadenectomy) : The wound is assessed to determine whether it can be closed primarily without tension by mobilizing adjacent tissue, should the Sure-Closure skin stretchers be used, or whether it requires a graft or flap.
[Tissue lateral to the margin of the wound is undermined by sharp and blunt dissection. Closed suction drains are placed in the ischial rectal fossa.
Closure of the wound is begun in the perineal body by suturing the subcutaneous tissues for 3 or 4 cm up to the posterior fourchette of the vagina.
the posterior fourchette of the vagina.
The subcutaneous tissue of the thigh is sutured to the paravaginal tissue up to the level of the urethral meatus
The subcutaneous tissue, from both sides of the incision lateral to the labia majora up to the pubic tubercle, is closed to the paravaginal tissue with interrupted 2-0 synthetic absorbable sutures.
Closed suction drains are placed in the ischial rectal fossa and under the closure of the vagina to the skin of the thigh.
The skin of the lower abdomen is mobilized up to the umbilicus. There must be no tension on the suture line between the incision overlying the inguinal ligament and the margin of the skin of the lower abdomen.
The mobilized lower abdomen is pulled down and sutured to the inguinal area in two layers.
The skin margins have been approximated with interrupted mattress sutures of 3-0 nylon. Suction drains have been placed in each inguinal area and through the lower abdomen.]
So, now decide how much the closure involvs and which are all the areas covered.
It is a rare encounter for a coder to get an opportunity to assign codes and it really has to come from who has coded &billed already such surgery.
Thank you and I await a good response from an experienced coder.