© Copyright 2025 American Medical Association. All rights reserved.
The CPT® Code 40820 refers to the destruction of lesions or scars located in the vestibule of the mouth using various physical methods. This procedure is typically performed to remove abnormal tissue that may be causing discomfort or presenting a risk of further complications. The term "vestibule of the mouth" refers to the area between the gums and the inner lining of the lips and cheeks. During the procedure, the lesion is carefully examined to determine the most suitable method of destruction based on its characteristics and the patient's specific needs. Local anesthesia may be administered to ensure patient comfort throughout the process. Several techniques can be employed for the destruction of the lesion, including cryosurgery, which utilizes liquid nitrogen to freeze the tissue, effectively destroying it. Another common approach is surgical curettage, which involves scraping away the lesion, often followed by electrosurgery to ensure complete removal and minimize bleeding. Additionally, chemosurgery may be performed using a chemotherapeutic agent, such as 5-fluorouracil (5-FU), to target and destroy the abnormal cells. Laser destruction, particularly with a carbon dioxide laser, is also a viable option, providing precision and reducing damage to surrounding healthy tissue. Each of these methods aims to effectively eliminate the lesion while promoting healing and minimizing discomfort for the patient.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure described by CPT® Code 40820 is indicated for the treatment of lesions or scars located in the vestibule of the mouth. These lesions may present as abnormal growths, ulcers, or other tissue changes that could lead to discomfort, functional impairment, or potential malignancy. The specific indications for performing this procedure include:
The procedure for CPT® Code 40820 involves several key steps to ensure effective destruction of the lesion or scar. The following procedural steps are typically followed:
Following the procedure coded by CPT® 40820, patients may experience some discomfort or swelling in the treated area. It is important for healthcare providers to give clear post-procedure care instructions, which may include recommendations for pain management, oral hygiene practices, and signs of potential complications to watch for, such as excessive bleeding or signs of infection. Patients are typically advised to avoid irritating the area and to follow up with their healthcare provider as needed to monitor healing and assess the outcome of the procedure. The expected recovery time may vary depending on the method used and the individual patient's healing response.
| Short Descr | TREATMENT OF MOUTH LESION | Medium Descr | DSTRJ LES/SCAR VESTIBULE MOUTH PHYSICAL METHS | Long Descr | Destruction of lesion or scar of vestibule of mouth by physical methods (eg, laser, thermal, cryo, chemical) | Status Code | Active Code | Global Days | 010 - Minor Procedure | 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 | Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS nonfacility PE RVUs; payment based on MPFS nonfacility PE RVUs. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P6C - Minor procedures - other (Medicare fee schedule) | MUE | 2 | CCS Clinical Classification | 33 - Other OR therapeutic procedures on nose, mouth and pharynx |
| 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.) | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | 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). | 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.) | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | 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 | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | 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) | 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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