2025 CPT code 40530
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Digestive System Surgery Feed
Excision of more than one-fourth of a lip; without reconstruction.
Modifiers 22 (increased procedural services), 51 (multiple procedures), 52 (reduced services), 59 (distinct procedural service) may be applicable depending on the circumstances.
Medical necessity is established by the presence of a lesion or injury to the lip requiring excision. The extent of the lesion dictates whether this code or a more extensive reconstruction code is appropriate.Documentation should support the medical necessity for lip resection, such as the presence of a tumor, significant trauma, or other pathology.
The provider prepares the patient, administers anesthesia, incises the lip, resects the affected tissue, closes the area with sutures, and repairs the incision in layers.Reconstruction is not performed.
In simple words: The doctor removes more than one-quarter of the patient's lip. This doesn't include rebuilding the lip; it's often done to remove a tumor.
This procedure involves the excision of more than one-fourth of the patient's lip.The diseased or damaged area and surrounding tissue are resected. The area is then closed and the incision repaired in layers using sutures.Reconstruction of surrounding structures is not included.
Example 1: A patient presents with a large benign tumor on their lower lip. The surgeon performs a wide excision of more than one-quarter of the lip to remove the tumor, ensuring clear margins. The incision is closed primarily with sutures., A patient sustains a significant laceration to their upper lip, involving more than one-fourth of the lip's tissue. The surgeon performs debridement and excision of the damaged tissue, followed by layered closure with sutures., A patient with a history of lip cancer undergoes a partial lip resection exceeding one-fourth of the lip for tumor removal. The surgeon performs the excision and primary closure, and the patient is referred to a reconstructive surgeon for further management.
Preoperative and postoperative photographs, operative report detailing the extent of resection, type of closure, and any complications. Pathology report confirming the diagnosis and demonstrating clear surgical margins.
** This code excludes lip reconstruction.Separate codes are used for reconstruction procedures.The size of the excision determines the appropriate code selection.Accurate documentation of the extent of resection is crucial for appropriate coding.
- Revenue Code: P5E (AMBULATORY PROCEDURES - OTHER)
- Payment Status: Active
- Specialties:Oral and Maxillofacial Surgery, Plastic Surgery, General Surgery
- Place of Service:Office, Ambulatory Surgical Center, Hospital Inpatient, Hospital Outpatient