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The procedure described by CPT® Code 40818 involves the excision of the mucosa from the vestibule of the mouth, which serves as a donor graft. This procedure is typically performed to obtain a mucosal graft that can be used in various reconstructive surgeries. The vestibule of the mouth is the area between the lips and the gums, and the mucosa in this region is rich in vascular supply, making it an ideal choice for grafting. During the procedure, careful attention is given to the surrounding anatomical structures, including the parotid duct, which is a major salivary duct located near the area of excision. The surgeon identifies and cannulates the parotid duct as necessary to prevent any damage during the graft harvesting process. The graft is meticulously outlined and excised using precise incisions, ensuring that the harvested tissue is suitable for transplantation. Following the excision, the defect left in the buccal mucosa is repaired with sutures, ensuring proper healing and restoration of the mucosal surface. This procedure is essential in various clinical scenarios where mucosal grafting is required for reconstruction or repair of oral defects.
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The excision of mucosa of the vestibule of the mouth as a donor graft is indicated for several clinical scenarios, including:
The procedure for excising the mucosa of the vestibule of the mouth as a donor graft involves several critical steps:
Post-procedure care following the excision of the mucosa of the vestibule of the mouth includes monitoring the surgical site for any signs of infection or complications. Patients are typically advised on oral hygiene practices to maintain cleanliness and promote healing. Pain management may be necessary, and the use of prescribed analgesics can help alleviate discomfort. Follow-up appointments are essential to assess the healing process of both the donor site and the recipient site where the graft has been placed. Additionally, patients may receive instructions regarding dietary modifications to avoid irritation to the surgical area during the initial recovery phase.
| Short Descr | EXCISE ORAL MUCOSA FOR GRAFT | Medium Descr | EXC MUCOSA VESTIBULE MOUTH AS DON GRF | Long Descr | Excision of mucosa of vestibule of mouth as donor graft | 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 | 172 - Skin graft |
| 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). | 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. | 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). | 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). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | E1 | Upper left, eyelid | E2 | Lower left, eyelid | E3 | Upper right, eyelid | E4 | Lower right, eyelid | 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 | KX | Requirements specified in the medical policy have been met | LT | Left side (used to identify procedures performed on the left side of the body) | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | 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 |
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| Pre-1990 | Added | Code added. |
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