40650-40654 Myth Buster: Get the Truth Behind 3 Problem Areas for Lip Repair Codes

Reimbursement for full-thickness lip-repair codes 40650-40654 ranges from about $300 to $600 on the MPFS, so you want to be sure you use these codes correctly. Watch out for three common myths that can lead to reporting errors for these codes:

  • 40650 (Repair lip, full thickness; vermilion only)
  • 40652 (… up to half vertical height)
  • 40654 (… over one-half vertical height, or complex).

Myth 1: You Can’t Use 40650-40654 for Surgically Created Wounds

Codes 40650-40654 may be appropriate for repair of laceration or surgically created wounds, according to AMA CPT® Assistant (July 2000). For instance, you may determine it’s appropriate to use one of these codes when the surgeon repairs a full-thickness Mohs surgical defect.

Myth 2: ED Coders Don’t Need to Check the Global for 40650-40654

Lip repair is a common service in emergency departments. One issue ED coders need to watch for is that codes 40650-40654 have a 90-day global period on the Medicare Physician Fee Schedule (MPFS). A 90-day global period means the reimbursement includes related services during a one-day preoperative period and 90-day postoperative period.

If the ED physician performs the repair but does not plan to provide the follow-up care, the ED claim should add modifier 54 (Surgical care only) to the repair code.

Tip: If the patient returns to the ED for suture removal after you’ve submitted the procedure code with modifier 54, you may report the appropriate ED E/M code, according to AMA CPT® Assistant (November 2016).

Myth 3: 40650-40654 Are Always the Correct Codes for Lip Repair

CPT® provides a lot of options for lip repair, so keep in mind that 40650-40654 are specific to full-thickness repair, with 40650 for repair that does not cross the vermillion border, and 40652 and 40654 for cases that do cross the vermillion border.

For repair involving the integumentary system, you’ll want to learn more about these code ranges:

  • 12011-12018 (Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes …)
  • 12051-12057 (Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes …)
  • 13151-13153 (Repair, complex, eyelids, nose, ears and/or lips …).

Don’t forget: Depending on the type of service performed, a more specific code such as one from 14060-14061 (Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips …) may be appropriate. When sutures aren’t involved, there are codes like G0168 (Wound closure utilizing tissue adhesive(s) only) to consider, too.

What About You?

Do you find lip repair coding confusing? What documentation clues do you use to help you identify which codes to use?


Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

, , , , , ,

Leave a Reply