2025 CPT code 40527
(Active) Effective Date: N/A Revision Date: N/A Surgery - Lip Excision with Reconstruction Digestive System Feed
Excision of a full-thickness lip defect; reconstruction using a cross-lip flap (Abbe-Estlander technique).
Modifiers may apply based on circumstances, such as multiple procedures (modifier 51) or reduced services (modifier 52).Always refer to the most current CPT guidelines for modifier usage.
The medical necessity for this procedure is typically established by the presence of a significant full-thickness lip defect that compromises the patient's ability to eat, speak, or maintain an acceptable appearance.The size and location of the defect must be clearly documented in the medical record.
The otolaryngologist or plastic surgeon is typically responsible for this procedure. This includes preoperative assessment, surgical planning and execution, and postoperative care. Anesthesiologist may participate in patient care.
In simple words: The doctor removes a damaged part of the lip, including all layers of the lip tissue.Then, they take a piece of tissue from the other lip and move it to the damaged area to repair it.
This procedure involves the complete excision of a full-thickness section of the lip, encompassing all layers including the epidermis, dermis, and mucosa.The defect is then repaired using a cross-lip flap, specifically the Abbe-Estlander technique, where a full-thickness segment of tissue from the opposite lip is transferred to reconstruct the excised area.Sutures are used to secure the flap and achieve wound closure. This technique is commonly used to address large lip defects.
Example 1: A patient presents with a large, full-thickness lip defect due to trauma (e.g., dog bite). The surgeon performs an Abbe-Estlander flap to reconstruct the lip., A patient with a significant lip defect resulting from a previous surgery requires revision surgery with a cross-lip flap to correct the aesthetic and functional issues., A patient with a large cancerous lesion on their lip undergoes surgical excision, and the defect is closed using an Abbe-Estlander flap following appropriate pathological confirmation.
** Accurate coding requires careful documentation of the surgical procedure, including the precise technique used and the size and location of the lip defect.Ensure all documentation requirements are met to ensure appropriate reimbursement.
- Revenue Code: P5E (AMBULATORY PROCEDURES - OTHER)
- RVU: Refer to CMS relative value units for the most up-to-date information.RVUs vary by geographic location and other factors.
- Global Days : The global period for this procedure will depend on the complexity and extent of the surgery and is determined by payer-specific guidelines and local standards. Consult your payer's guidelines for specific details.
- Payment Status: Active
- Modifier TC rule: This procedure does not typically have a technical component (TC) modifier.
- Fee Schedule : Historical fee schedules can vary significantly depending on location, payer, and time period.Consult historical billing data or fee schedule databases for specific historical information.
- Specialties:Plastic Surgery, Oral and Maxillofacial Surgery, Otolaryngology
- Place of Service:Office, Ambulatory Surgical Center, Hospital (Inpatient or Outpatient)