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A full thickness excision of the lip involves the surgical removal of tissue from the lip, which is then reconstructed using a local flap technique. This procedure is commonly referred to as an Estlander or fan flap, and it may also involve a cross lip flap, known as the Abbe-Estlander flap. The process begins with the careful marking of incision lines on the lip using a surgical marking pen, ensuring that if the excision is performed to remove a lesion, there is a margin of healthy tissue included around the lesion to promote healing and reduce the risk of recurrence. Local anesthesia, often combined with epinephrine, is administered to minimize discomfort and control bleeding during the procedure. The surgical technique involves a wedge resection, where the lip is incised perpendicularly through both the cutaneous lip and the vermilion, converging at the white part of the lip to remove a wedge-shaped section of tissue. Following the excision, the defect is reconstructed using a local flap, which includes both cutaneous lip and vermilion tissue, and is advanced over the defect to restore the lip's appearance and function. In some cases, a cross lip flap may be utilized, which is a more complex two-stage procedure involving the transfer of tissue from one lip to the other, ensuring adequate blood supply through the labial artery. This comprehensive approach to lip reconstruction aims to achieve optimal aesthetic and functional outcomes for the patient.
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The procedure is indicated for the excision of lesions or defects located on the lip, which may include various types of tumors, cysts, or other pathological conditions that necessitate surgical intervention. The full thickness excision is performed to ensure complete removal of the lesion while preserving surrounding healthy tissue for optimal healing and reconstruction.
The procedure begins with the careful marking of incision lines on the lip using a surgical marking pen. This step is crucial for ensuring precision during the excision. If the procedure is being performed to remove a lesion, the incision line is designed to include a margin of healthy tissue surrounding the lesion. Following this, local anesthesia is administered, often combined with epinephrine to help control bleeding during the surgery. The next step involves performing a wedge resection of the lip. The surgeon incises the lip perpendicularly through the cutaneous lip and vermilion on both sides of the lesion or defect. As the incision reaches the white part of the lip, the incisions on either side converge, allowing for the removal of a wedge-shaped piece of tissue. After the excision, the defect is repaired using a local flap. The incision lines for the flap are marked on the skin, and the flap is designed to include both cutaneous lip and vermilion. The incision is carried down through the orbicularis muscle while leaving the underlying mucosa intact. The flap is then advanced over the defect to reconstruct the lip, restoring its appearance and function.
Post-procedure care involves monitoring the surgical site for signs of infection and ensuring proper healing. Patients may be advised to follow specific oral hygiene practices to maintain cleanliness around the surgical area. Pain management may be necessary, and the use of ice packs can help reduce swelling. Follow-up appointments are essential to assess the healing process and to remove any sutures if applicable. Patients should be informed about potential complications, such as scarring or changes in lip sensation, and instructed to report any unusual symptoms to their healthcare provider.
| Short Descr | RECONSTRUCT LIP WITH FLAP | Medium Descr | EXC LIP FULL THKNS RCNSTJ W/LOCAL FLAP | Long Descr | Excision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) | 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 |
| 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. | 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. | 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.) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | RT | Right side (used to identify procedures performed on the right side of the body) | SG | Ambulatory surgical center (asc) facility service | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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