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The procedure described by CPT® Code 40654 involves a full-thickness repair of the lip that exceeds one-half of the vertical height or is classified as complex. The lips are anatomically structured into three primary regions: the cutaneous, vermilion, and mucosal areas. The cutaneous region encompasses the outer skin of the lips, while the vermilion region is the pinkish-red area that is more delicate and consists of modified mucosal membrane. The mucosal portion is located inside the mouth and is adjacent to the teeth. In contrast to CPT® Code 40650, which focuses solely on the vermilion, the procedure under CPT® Code 40654 entails a comprehensive approach that includes the repair of the dermis and subcutaneous tissue of the cutaneous lip, in addition to the vermilion. The repair process is meticulous, beginning with the submucosa, followed by the orbicularis oris muscle, and concluding with the vermilion, ensuring that the vermilion border is precisely aligned. If the injury involves the mucosa, it may be addressed either before or after the repair of the vermilion and cutaneous lips. This code is specifically utilized for lacerations that are more extensive than half the vertical height of the lip or those that necessitate complex repair techniques, which may include debridement, extensive undermining, or the use of stents and retention sutures to achieve a satisfactory cosmetic result.
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The procedure associated with CPT® Code 40654 is indicated for the following conditions:
The procedure begins with the assessment of the lip laceration to determine the extent of the injury. The surgeon first addresses the submucosa, utilizing small-caliber, soft, nonirritating suture material to ensure that the knots are buried, minimizing irritation to the surrounding tissues. Following this, the orbicularis oris muscle is repaired using absorbable sutures, which allows for a secure closure without the need for suture removal later. The next step involves the meticulous repair of the vermilion, where careful alignment of the vermilion border is crucial to restore the natural appearance of the lip. After the vermilion is repaired, the surgeon proceeds to close the dermis and subcutaneous tissue of the cutaneous lip, ensuring that the layers are properly aligned to promote healing. The final step involves the closure of the epidermis, which is everted to prevent any depression and to minimize scarring. In cases where the mucosa is involved, such as with a through-and-through laceration, the mucosal layer may be repaired either before or after the closure of the vermilion and cutaneous lips, depending on the specific circumstances of the injury.
Post-procedure care for patients undergoing a repair under CPT® Code 40654 typically includes instructions for wound care to prevent infection and promote healing. Patients may be advised to avoid certain activities that could stress the repaired area, such as vigorous physical activity or excessive facial movements. Follow-up appointments are essential to monitor the healing process and to remove any non-absorbable sutures if used. Patients should also be informed about signs of complications, such as increased swelling, redness, or discharge, which may indicate infection or other issues requiring medical attention. Overall, the expected recovery involves gradual healing of the lip, with attention to maintaining the cosmetic appearance of the repaired area.
| Short Descr | RPR LIP FTH>1HALF VER HT/CPX | Medium Descr | RPR LIP FTH OVER ONE-HALF VERT HEIGHT/COMPLEX | Long Descr | Repair lip, full thickness; over one-half vertical height, or complex | 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). | 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. | 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. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 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.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | GA | Waiver of liability statement issued as required by payer policy, individual case | 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 | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | SG | Ambulatory surgical center (asc) facility service | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner | 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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| 2024-01-01 | Changed | Short and Medium Descriptions changed. |
| 2013-01-01 | Changed | Medium Descriptor changed. |
| Pre-1990 | Added | Code added. |
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