2025 CPT code 40720

Secondary plastic repair of cleft lip or nasal deformity; by recreation of defect and reclosure.

Refer to the AMA CPT manual and payer-specific guidelines for the most up-to-date information on appropriate code usage and documentation requirements.

Modifier 50 (bilateral procedure) can be appended if the secondary repair addresses both sides of the face simultaneously.

Medical necessity is established when the primary cleft lip or nasal repair resulted in an unacceptable aesthetic or functional outcome, requiring a secondary revision to achieve a better result.Documentation must clearly justify the need for the secondary procedure, often referencing complications, failures, or unsatisfactory initial results.

The plastic surgeon or a qualified specialist is responsible for performing this surgery.This includes pre-operative planning, intraoperative technique, and postoperative care.Proper anesthesia management is also a critical element.

IMPORTANT For bilateral procedures, use modifier 50.For rhinoplasty addressing only nasal deformity secondary to congenital cleft lip, consider codes 30460 or 30462. For cleft lip repair with a cross-lip pedicle flap (Abbe-Estlander type), use code 40527.Primary cleft lip repairs are coded using 40700, 40701, or 40702 depending on the specifics of the case.

In simple words: This code represents a second surgery to fix a problem with a previous surgery to repair a cleft lip or nose. The doctor reopens the area, cleans it up, and closes it again to improve the result of the first surgery.

This CPT code, 40720, describes a secondary surgical procedure to correct a cleft lip or nasal deformity that wasn't adequately addressed by an initial (primary) repair.The procedure involves reopening the affected area (recreating the defect) to achieve clean surgical margins and then carefully reclosing the site. This is necessary to address unfavorable outcomes from the primary repair, such as scar contractures, wound dehiscence (splitting), muscle shortening restricting movement, or infection. The surgeon meticulously repairs the mucosa, muscle, and skin layers, ensuring proper alignment and function. This is distinct from a primary cleft lip repair, typically coded using 40700, 40701, or 40702, depending on the extent and laterality.

Example 1: A patient underwent primary cleft lip repair as an infant.Years later, scar contracture causes noticeable asymmetry and functional limitations.Code 40720 is used for the revision surgery to correct these issues., A patient had a cleft lip repair that resulted in wound dehiscence (opening).A secondary repair (40720) is needed to close the wound and restore lip integrity., A patient with a cleft lip and nose had a primary repair where the nasal component did not heal well.Code 40720 is reported for the secondary repair to address nasal deformity in this case.

** Accurate coding requires careful review of the operative report and supporting documentation to ensure the procedure performed aligns with the description for code 40720.The specific approach and complexity of the secondary repair will influence the overall assessment of medical necessity and coding choice.

  • Revenue Code: P1G (Major Procedure - Other)
  • RVU: This information requires access to current RVU data from a payer or a commercial RVU database.The RVUs will vary based on geographic location and payer.
  • Global Days : The global period for this procedure needs to be determined based on payer guidelines and local practice customs; it likely includes the immediate postoperative period.
  • Payment Status: Active
  • Modifier TC rule: This code does not typically require a TC (Technical Component) modifier. However, depending on the specific circumstances and payer requirements, appropriate modification must be made.
  • Fee Schedule : Historical fee schedule data is not included here.This information is specific to payer contracts and can be found through the payer or a billing service.
  • Specialties:Plastic Surgery, Craniofacial Surgery, Pediatric Surgery
  • Place of Service:Office, Ambulatory Surgical Center, Hospital (Inpatient or Outpatient)
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