Oral Surgery Coding & Reimbursement Alert

Published on Tue Nov 25, 2014 PDF

Question: If our oral surgeon performed destruction of multiple lesions in the vestibule of the mouth or on the inner aspects of the lips, what CPT® codes do I report for the procedure? Also, should I report only one unit of the code for all the lesions that were destroyed, or should I report one unit for each lesion that was destroyed?

California Subscriber 

Answer: When your oral surgeon performs a destruction of a lesion in the oral vestibule or on the inner aspect of the lips using a laser, heat or a chemical, you will report the procedure with the CPT® code 40820 (Destruction of lesion or scar of vestibule of mouth by physical methods [e.g., laser, thermal, cryo, chemical]). 

If your surgeon excised a mucosal or submucosal lip- or cheek-tissue lesion, you would choose from the following options depending on whether or not your clinician performed any repair procedure:

• 40810 (Excision of lesion of mucosa and submucosa, vestibule of mouth; without repair)
• 40812 (…with simple repair)
• 40814 (…with complex repair)
• 40816 (…complex, with excision of underlying muscle).

You will have to report one unit of the code for each lesion that was destroyed. You have to code only completely distinct additional lesions your surgeon destroyed. If the lesions share borders or are adjacent, you should not code separate destructions.

Wait to file the claim until you have the pathology report. The diagnoses may help you to substantiate coding an additional 40820. For instance, if the lip lesions come back as cancerous, and documentation shows they are on the upper and lower lip, you would report on separate lines:

• 40820 linked to 140.3 (Malignant neoplasm of upper lip, inner aspect)
• 40820-59 linked to 140.4 (... lower lip, inner aspect).

When you have the same diagnosis, for instance, two separate-location upper lip mucosal lesions (140.3), you may be able to report the destruction with 40820 x 2. To avoid the carrier considering the second 40820 duplicate, you may need to append modifier 59 (Distinct procedural service) to the second 40820.