2025 CPT code 40525
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Digestive System Surgery Feed
Excision of lip; full thickness, reconstruction with local flap (e.g., Estlander or fan).
Modifiers may be applicable depending on the circumstances of the procedure. Examples include modifiers for multiple procedures (51), reduced services (52), or anesthesia (47). Consult the CPT manual and payer-specific guidelines for details.
Medical necessity is established when the excision and reconstruction are required to address a pathologic condition (e.g., malignant or pre-malignant lesion) or to repair a traumatic injury.In cases of non-malignant lesions, medical necessity may be justified based on aesthetic concerns or functional impairment.
The clinical responsibility lies with a surgeon or other qualified healthcare professional skilled in performing lip surgery.This includes pre-operative evaluation, surgical technique, post-operative care, and follow-up monitoring.Anesthesia may be provided by the surgeon or a qualified anesthesiologist.
In simple words: The doctor removes a damaged area of the lip, including all layers, and then repairs it using nearby skin. This is often done to fix a wound or abnormal growth on the lip.
This CPT code describes the surgical excision of a full-thickness area of the lip, followed by reconstruction using a local flap.The procedure involves precise incision of the affected lip area and mucosa, often utilizing a V-shaped incision to remove the lesion and surrounding healthy tissue margins.Local skin flaps are then created and meticulously sutured in place to close the wound, restoring lip integrity.Examples of local flaps used include the Estlander flap (a full-thickness lip flap transferred from one side of the lip to the other) or a fan flap. The choice of flap depends on the size, location, and nature of the defect.
Example 1: A patient presents with a 1cm squamous cell carcinoma on the lower lip.The surgeon performs a full-thickness excision of the lesion with a 3mm margin of healthy tissue and reconstructs the defect using a local advancement flap. This scenario requires a thorough surgical technique to ensure complete tumor removal while maintaining lip functionality and aesthetics., A patient sustains a traumatic laceration involving the full thickness of the lower lip. The surgeon performs excision of devitalized tissue and reconstructs the defect using an Estlander flap.This scenario highlights the use of specific flap techniques depending on the location and size of the defect., A patient presents with a benign but aesthetically displeasing lesion on the upper lip. The surgeon excises the lesion using a V-shaped incision and reconstructs the defect using a local fan flap to minimize scarring and maintain the natural lip contour.This scenario demonstrates the use of the procedure for non-malignant lesions.
* Pre-operative photographs and documentation of the lesion's size, location, and characteristics.* Operative report detailing the surgical technique, type of flap used, and extent of resection.* Post-operative photographs documenting wound healing and aesthetic outcome.* Pathology report confirming the diagnosis and margins of resection.* Patient's medical history including any relevant comorbidities.
** The description of the procedure includes the use of local flaps.The specific type of flap used (e.g., Estlander, fan) should be documented in the operative report.Accurate documentation is crucial for appropriate reimbursement and proper clinical record keeping.
- Revenue Code: P5E (AMBULATORY PROCEDURES - OTHER)
- RVU: RVU information is not included in the provided data.Consult your local payer's fee schedule for current RVU values and reimbursement rates.
- Global Days : The global period for this procedure is not specified in the source data. Refer to your local Medicare Administrative Contractor (MAC) guidelines for specific information.
- Payment Status: Active
- Modifier TC rule: The application of a Technical Component (TC) modifier is not typically applicable to this code, as the procedure is usually performed by a surgeon.
- Fee Schedule : Historical fee schedule information is not included in the data.Consult historical CPT fee schedule databases or payer-specific documentation for relevant information.
- Specialties:Plastic Surgery, Oral and Maxillofacial Surgery, Otolaryngology
- Place of Service:Office, Ambulatory Surgical Center, Hospital (Inpatient or Outpatient)