Lip procedures
Lip procedure codes: In a nutshell
- When coding for a lip procedure, you must specify the exact location on the lip where the procedure was performed, either on the skin or within the vermilion border.
- Correctly coding a lip biopsy requires two steps: determining whether the biopsy was performed on the skin and ensuring that you chose the most exact code possible (11102 – 11107).
- There are also multiple lip-specific CPT codes dealing with excisional surgery and reconstruction.
Coding for lip biopsies in two steps
Lip biopsy coding is a two-step process.
Step 1: Determine whether the biopsy was done on the skin of the lip or within the vermilion border.
Code 40490 is reported when the tissue sample is obtained within the vermilion border (margins) of the lip and mucosa. For biopsies on the skin of the lip (between the nose and the vermilion border), see skin biopsy codes 11102 - 11107.
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Step 2: Ensure the proper code is assigned and billed.
Document the precise location carefully. Just writing “biopsy of the lip” will likely result in the payer denying the claim. Ensure your coding and billing team are adequately trained to recognize the location specificity of the lip biopsy code as indicated in your medical record documentation, and to assign the appropriate code.
Surgery and reconstruction codes
Lip procedures can be difficult to bill for, even when you’re not doing a biopsy. There are multiple lip-specific CPT codes that deal with excisional surgery and reconstruction, including:
Height matters
For lip repair procedures, the correct code may be dependent on height. How exactly do you measure height when billing for a lip repair?
The upper lip: The top border is the nasal alar rim and the cheek fold. The bottom border is the inferior edge of the vermilion.
The lower lip: The lower lip begins at the bottom of the top lip and ends at the mental crease (inferior to which is the chin).
You can test your knowledge of surgical and procedural coding by taking short Academy quizzes, or see coding quizzes on other subjects.
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