How To Use CPT Code 40654

CPT 40654 describes the repair of a full-thickness tear of the lip that is over one-half the vertical height using sutures. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 40654?

CPT 40654 can be used to describe the repair of a full-thickness tear of the lip that is more than one-half the vertical height using sutures. This code is used when a provider closes a deep cut or tear in the skin or flesh of the lip.

2. Official Description

The official description of CPT code 40654 is: ‘Repair lip, full thickness; over one-half vertical height, or complex.’

3. Procedure

1. The provider preps and anesthetizes the patient.
2. The provider closes the full-thickness tear of the lip using sutures.
3. The tear is larger than half of the vertical height of the lip.
4. The provider applies a dressing to the incision.

4. Qualifying circumstances

Patients eligible to receive CPT 40654 services are those with a full-thickness tear of the lip that is over one-half the vertical height. This procedure is commonly performed for wounds of the lips that occur due to trauma or that are created surgically. The provider must close the tear with sutures and apply a dressing.

5. When to use CPT code 40654

CPT code 40654 should be used when a provider repairs a full-thickness tear of the lip that is over one-half the vertical height using sutures. This code should not be used for repairs of an area less than half the vertical height of the lips or for repairs of a full-thickness laceration that only involves the vermilion border.

6. Documentation requirements

To support a claim for CPT 40654, the provider must document the following information:

• Description of the full-thickness tear of the lip
• Details of the repair procedure, including the use of sutures
• Date of the procedure
• Start and end time of the procedure
• Any additional procedures performed
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 40654, ensure that the provider performs a repair of a full-thickness tear of the lip that is over one-half the vertical height using sutures. Do not report CPT 40654 for repairs of an area less than half the vertical height of the lips or for repairs of a full-thickness laceration that only involves the vermilion border. Consider using modifier 26 for professional component billing and modifier TC for technical component billing if applicable.

8. Historical information

CPT 40654 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A provider repairs a full-thickness tear of the lip that is over one-half the vertical height using sutures.
2. A patient sustains a deep cut on their lip due to a traumatic injury, and a provider performs a repair using sutures.
3. A provider surgically creates a full-thickness tear of the lip that is over one-half the vertical height and then repairs it using sutures.
4. A patient undergoes a lip reconstruction procedure, and a provider repairs a full-thickness tear of the lip that is over one-half the vertical height using sutures.
5. A provider performs a repair of a full-thickness tear of the lip that is over one-half the vertical height using sutures after removing a lip tumor.
6. A patient requires a repair of a full-thickness tear of the lip that is over one-half the vertical height due to a congenital lip deformity, and a provider performs the procedure using sutures.
7. A provider repairs a full-thickness tear of the lip that is over one-half the vertical height using sutures after a lip augmentation procedure.
8. A patient undergoes a lip reduction procedure, and a provider repairs a full-thickness tear of the lip that is over one-half the vertical height using sutures.
9. A provider performs a repair of a full-thickness tear of the lip that is over one-half the vertical height using sutures after a lip reconstruction following a burn injury.
10. A patient sustains a full-thickness tear of the lip that is over one-half the vertical height due to a dog bite, and a provider performs a repair using sutures.