2025 CPT code 40808
Biopsy of the vestibule of the mouth.
Modifiers may apply based on specific circumstances such as multiple procedures (modifier 51), reduced services (modifier 52), or anesthesia provided by a different physician (modifier 47).Consult current modifier guidelines.
Medical necessity for a vestibule of the mouth biopsy is established when there is a clinically significant finding (e.g., lesion, ulcer, area of inflammation) that requires further evaluation to rule out or diagnose a pathological condition, such as oral cancer, infection, or other mucosal disorders.
The physician is responsible for performing the biopsy, preparing the patient (including anesthesia), excising the tissue sample with appropriate margins, and sending the sample to the laboratory for analysis. The pathologist is responsible for interpreting the results of the biopsy.
In simple words: The doctor takes a small sample of tissue from the area inside the mouth between the lips/cheeks and the gums (called the vestibule) to test for a problem.
This CPT code describes the surgical removal of a tissue sample from the vestibule of the mouth for pathological examination.The procedure involves incising the lesion and excising it along with margins of healthy tissue. The excised tissue is then sent to a laboratory for analysis to diagnose an oral mucosal abnormality.
Example 1: A patient presents with a suspicious lesion on the inner cheek. The physician performs a biopsy of the lesion using a scalpel. The sample is sent to pathology, which confirms a benign condition., A patient with a history of oral cancer undergoes a routine follow-up examination. During the examination, the physician detects a new area of concern in the vestibule of the mouth and decides to perform a biopsy., A patient complains of persistent pain and inflammation in the area between their lip and gum. A biopsy is performed using a laser, and the pathology report reveals a chronic inflammatory condition.
* Detailed clinical history and physical examination notes describing the lesion.* Documentation of the size, location, and characteristics of the lesion.* Description of the surgical technique used (e.g., scalpel, laser).* Size and number of tissue samples excised.* Pathology report with diagnosis.* Indication for the biopsy (e.g., suspicion of malignancy, evaluation of ulcer).* Appropriate informed consent documentation.
** The vestibule of the mouth is the space between the lips/cheeks and the teeth and gums.The biopsy can be performed using various techniques, such as scalpel excision, laser ablation, or punch biopsy. The choice of technique should be documented.Appropriate coding requires a detailed understanding of the location and nature of the lesion. If the lesion extends beyond the vestibule of the mouth, different codes may apply.
- Revenue Code: P6C (MINOR PROCEDURES - OTHER)
- RVU: This information is not available in the provided source.Consult the AMA CPT codebook or a relevant fee schedule for RVU values.
- Global Days: The global period for this procedure is not specified in the provided source.This should be determined based on payer-specific guidelines.
- Payment Status: Active
- Modifier TC rule: This information is not available in the provided source. Refer to official CPT guidelines and payer-specific rules.
- Fee Schedule: This information is not available in the provided sources.Consult historical fee schedules from the relevant payer.
- Specialties:Oral and Maxillofacial Surgery, Dentistry, Otolaryngology
- Place of Service:Office, Hospital (Inpatient or Outpatient), Ambulatory Surgical Center