How To Use CPT Code 40805

CPT 40805 describes the removal of an embedded foreign body in the vestibule of the mouth, specifically in cases that are complex or complicated. 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 40805?

CPT 40805 is used to describe the removal of an embedded foreign body in the vestibule of the mouth. This code is specifically applicable when the procedure requires extended time or when the case is complex or complicated. The provider must indicate the complexity involved and the additional time taken in the operative report.

2. Official Description

The official description of CPT code 40805 is: ‘Removal of embedded foreign body, vestibule of mouth; complicated.’

3. Procedure

1. The provider prepares the patient and administers anesthesia.
2. The patient is asked to open their mouth wide.
3. An incision is made over the area in the oral cavity where the foreign body is located.
4. The provider uses forceps to grasp and remove the foreign body.
5. An antiseptic or bandage may be applied to the area for healing.

4. Qualifying circumstances

CPT 40805 is used when the removal of the embedded foreign body in the vestibule of the mouth requires extended time or when the case is complex or complicated. The provider must document the complexity involved and the additional time taken in the operative report.

5. When to use CPT code 40805

CPT code 40805 should be used when the removal of an embedded foreign body in the vestibule of the mouth is complex or complicated. It should not be used for simple removal procedures, which are described by CPT code 40804.

6. Documentation requirements

To support a claim for CPT 40805, the provider must document the following information:

• Complexity of the case and the need for extended time
• Description of the embedded foreign body
• Details of the procedure, including the incision and removal technique
• Application of antiseptic or bandage, if applicable

7. Billing guidelines

When billing for CPT 40805, ensure that the procedure meets the criteria for complexity or complication. It is important to document the additional time taken and the complexity involved in the operative report. CPT code 40805 should not be reported with CPT codes 40806 or any other codes for removal of foreign bodies in different locations.

8. Historical information

CPT 40805 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 removes a fishbone embedded in the vestibule of a patient’s mouth, which requires extended time and involves a complex case.
2. A dentist removes a broken tooth fragment embedded in the vestibule of a patient’s mouth, which requires additional time due to the complexity of the case.
3. A surgeon removes a metal splinter embedded in the vestibule of a patient’s mouth, which requires a complex procedure and extended time.
4. A maxillofacial surgeon removes a glass shard embedded in the vestibule of a patient’s mouth, which requires a complicated procedure and additional time.
5. An oral surgeon removes a dental implant screw embedded in the vestibule of a patient’s mouth, which requires extended time and involves a complex case.
6. A provider removes a wooden splinter embedded in the vestibule of a patient’s mouth, which requires additional time due to the complexity of the case.
7. A dentist removes a broken orthodontic wire embedded in the vestibule of a patient’s mouth, which requires a complex procedure and extended time.
8. A surgeon removes a plastic fragment embedded in the vestibule of a patient’s mouth, which requires a complicated procedure and additional time.
9. A maxillofacial surgeon removes a bone fragment embedded in the vestibule of a patient’s mouth, which requires extended time and involves a complex case.
10. An oral surgeon removes a metal wire embedded in the vestibule of a patient’s mouth, which requires additional time due to the complexity of the case.