CPT® Code 40720

1. Indications

The procedure described by CPT® Code 40720 is indicated for patients who have a cleft lip and associated nasal deformity that requires secondary repair. This may include individuals who have previously undergone primary repair but are experiencing complications or unsatisfactory aesthetic results. The indications for this procedure may include:

• Secondary Repair Necessity Patients requiring a secondary surgical intervention due to inadequate results from the initial cleft lip repair.
• Functional Impairment Individuals experiencing functional issues related to the lip or nasal structure that impact speech, feeding, or breathing.
• Aesthetic Concerns Patients seeking improvement in the appearance of the lip and nose following a primary repair.
• Scar Tissue Management Cases where scar tissue from previous surgeries needs to be excised or revised to improve function and appearance.

2. Procedure

The procedure for CPT® Code 40720 involves several detailed steps to ensure effective repair of the cleft lip and nasal deformity. These steps include:

• Step 1: Incision The surgeon begins by making incisions along the original lines of the previous repair. This allows access to the underlying tissues while minimizing additional scarring.
• Step 2: Scar Tissue Release The next step involves the careful release and excision of any scar tissue that has formed since the initial repair. This is crucial for restoring normal tissue mobility and function.
• Step 3: Undermining The surgeon then undermines the underlying tissues to create a tension-free environment for closure. This step is essential to ensure that the repaired lip and nose can heal properly without undue stress on the sutures.
• Step 4: Anatomical Landmark Identification The physician identifies key anatomical landmarks to guide the reconstruction process, ensuring that the repair aligns with the natural contours of the lip and nose.
• Step 5: Flap Advancement or Rotation The previously created flaps of tissue are advanced or rotated as necessary to restore the continuity of the orbicularis muscle and achieve a functional and aesthetic outcome.
• Step 6: Nasal Deformity Correction The nasal deformity is addressed by undermining the nasal skin and freeing it from the nasal skeleton, allowing for repositioning of the cartilaginous components of the nose.
• Step 7: Tissue Reapproximation The overlying tissues are then reapproximated to ensure a smooth and natural appearance of the lip and nose.
• Step 8: Closure Finally, all skin incisions are meticulously closed using fine sutures or skin adhesive to promote optimal healing and minimize scarring.

3. Post-Procedure

After the completion of the procedure, patients typically require careful monitoring and follow-up care to ensure proper healing. Post-procedure care may include instructions on wound care, pain management, and activity restrictions to avoid strain on the surgical site. Patients are often advised to keep the area clean and dry, and to follow up with their healthcare provider for suture removal or further evaluation as needed. The expected recovery period may vary depending on individual healing responses, but patients should be informed about potential signs of complications, such as infection or unusual swelling, that would necessitate immediate medical attention.