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The procedure described by CPT® Code 40650 involves a full thickness repair of the vermilion, which is the pink to red portion of the lips. The lips are anatomically divided into three regions: the cutaneous, vermilion, and mucosal areas. The cutaneous region includes the outer skin of the lips, while the mucosal region is located inside the mouth, adjacent to the teeth. The vermilion is a critical area for cosmetic and functional purposes, as it plays a significant role in the appearance of the lips and their ability to function during speech and eating. In this procedure, the surgeon focuses solely on repairing the vermilion, ensuring that the submucosa is addressed first with nonirritating suture material, followed by the repair of the orbicularis oris muscle using absorbable sutures. The final step involves meticulously aligning the vermilion border to restore the natural appearance of the lips. This procedure is essential for patients who have experienced trauma or defects in the vermilion area, allowing for both aesthetic restoration and functional improvement.
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The procedure associated with CPT® Code 40650 is indicated for the repair of full thickness defects specifically involving the vermilion of the lip. This may arise from various conditions, including:
The procedure for CPT® Code 40650 involves several critical steps to ensure a successful repair of the vermilion:
After the completion of the vermilion repair, patients may require specific post-procedure care to ensure optimal healing. This includes monitoring for signs of infection, managing pain, and following up with the surgeon for suture removal if non-absorbable sutures were used. Patients are typically advised to avoid certain activities that may stress the repaired area, such as vigorous physical activity or excessive facial movements, during the initial healing phase. Additionally, instructions regarding oral hygiene and diet may be provided to prevent irritation to the surgical site. The expected recovery time can vary, but careful adherence to post-operative guidelines is essential for achieving the best cosmetic and functional results.
| Short Descr | RPR LIP FTH VERMILION ONLY | Medium Descr | REPAIR LIP FULL THICKNESS VERMILION ONLY | Long Descr | Repair lip, full thickness; vermilion only | 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 | Procedure or Service, Multiple Reduction Applies | 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). | 54 | Surgical care only: when 1 physician or other qualified health care professional performs a surgical procedure and another provides preoperative and/or postoperative management, surgical services may be identified by adding modifier 54 to the usual procedure number. | 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. | 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 | CR | Catastrophe/disaster related | GC | This service has been performed in part by a resident under the direction of a teaching physician | GW | Service not related to the hospice patient's terminal condition | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | 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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| 2024-01-01 | Changed | Short and Medium Descriptions changed. |
| Pre-1990 | Added | Code added. |
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