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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 Abbe-Estlander flap, named after the surgical technique that utilizes a cross lip flap for reconstruction. 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 excision is performed in a precise manner, with incisions made perpendicularly through the cutaneous lip and vermilion on either side of the lesion. This technique allows for the removal of a wedge-shaped section of tissue, which is critical for addressing the defect created by the excision. Following the removal of the tissue, the reconstruction phase begins. Depending on the location of the defect—whether on the upper or lower lip—a specific type of flap is utilized. The Abbe-Estlander flap is particularly notable for its two-stage approach, where the flap is initially created and maintained with its blood supply intact before being transferred to the defect in a subsequent procedure. This meticulous approach ensures optimal healing and aesthetic 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 conditions such as:
The procedure consists of several critical steps that ensure both the excision of the lip and the subsequent reconstruction are performed effectively:
Post-procedure care involves monitoring the surgical site for signs of infection and ensuring proper healing of the flap. Patients are typically advised on wound care, which may include keeping the area clean and dry, and avoiding excessive movement of the lip to promote healing. Follow-up appointments are essential to assess the healing process and to determine when the second stage of the procedure can be performed. Patients may also receive guidance on dietary modifications to avoid irritation to the surgical site during the recovery period.
| Short Descr | RECONSTRUCT LIP WITH FLAP | Medium Descr | EXC LIP FULL THKNS RCNSTJ W/CROSS LIP FLAP | Long Descr | Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) | 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) | 0 - 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). | 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). | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | 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 |
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| Pre-1990 | Added | Code added. |
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