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The procedure known as vermilionectomy, specifically coded as CPT® Code 40500, involves the surgical removal of the vermilion portion of the lip, which is the pink to red area that is composed of modified mucosal membrane. The lips are anatomically divided into three distinct regions: the cutaneous, vermilion, and mucosal areas. The cutaneous region of the upper lip extends from the base of the nose to the nasolabial folds, while the lower cutaneous lip stretches from the vermilion border to the nasolabial folds and down to the mental crease at the chin. The vermilion area is crucial for aesthetic and functional purposes, and its excision is typically indicated for various pathological conditions. Vermilionectomy is performed to address issues such as actinic cheilitis, carcinoma in situ, and squamous cell carcinoma affecting the vermilion. During the procedure, an incision is made along the vermilion border of the affected lip, allowing for the excision of the vermilion tissue along the submucosal plane. Following this, the posterior lip mucosa is incised and developed to facilitate the reconstruction of the vermilion. The mucosal tissue is then advanced and carefully sutured to the cutaneous lip, effectively reconstructing the vermilion area.
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The procedure of vermilionectomy is indicated for several specific conditions affecting the vermilion area of the lips. These indications include:
The vermilionectomy procedure involves several critical steps to ensure effective removal and reconstruction of the vermilion area. The steps are as follows:
Post-procedure care following a vermilionectomy is essential for optimal healing and recovery. Patients are typically advised to follow specific instructions regarding wound care to prevent infection and promote healing. This may include keeping the surgical site clean and dry, avoiding certain foods that could irritate the area, and adhering to any prescribed medication for pain management. Patients should also be monitored for any signs of complications, such as excessive swelling, bleeding, or infection. Follow-up appointments are crucial to assess the healing process and ensure that the reconstruction of the vermilion is successful.
| Short Descr | PARTIAL EXCISION OF LIP | Medium Descr | VERMILIONECTOMY LIP SHV W/MUCOSAL ADVMNT | Long Descr | Vermilionectomy (lip shave), with mucosal advancement | 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) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5E - Ambulatory procedures - other | MUE | 2 | CCS Clinical Classification | 33 - Other OR therapeutic procedures on nose, mouth and pharynx |
| 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). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 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. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | GC | This service has been performed in part by a resident under the direction of a teaching physician | SG | Ambulatory surgical center (asc) facility service | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| Pre-1990 | Added | Code added. |
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