How To Use CPT Code 40806

CPT 40806 describes the incision of the labial frenum, also known as frenotomy. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 40806?

CPT 40806 is used to describe the incision of the labial frenum, which is the tag of tissue in the center of the upper or lower lip that attaches the lip to the gums. This procedure is performed by a healthcare provider to release a tight frenum and its surrounding tissues, without removing the frenum itself.

2. Official Description

The official description of CPT code 40806 is: ‘Incision of labial frenum (frenotomy).’ This procedure involves the provider making an incision in the labial frenum to release a tight frenum and its surrounding tissues.

3. Procedure

1. The healthcare provider prepares the patient and administers anesthesia.
2. The provider makes an incision in the labial frenum to release the tight frenum and its surrounding tissues.
3. The frenum is not removed during this procedure.

4. Qualifying circumstances

CPT 40806 is performed when a patient has a tight labial frenum that requires release. This condition may cause problems with the gums or create a gap between the two front teeth. The procedure is typically performed by a healthcare provider who has determined that the patient would benefit from a frenotomy.

5. When to use CPT code 40806

CPT code 40806 should be used when a healthcare provider performs an incision of the labial frenum to release a tight frenum and its surrounding tissues. It is important to note that this code should not be used if the frenum is completely removed during the procedure.

6. Documentation requirements

To support a claim for CPT 40806, the healthcare provider must document the following information:

• Patient’s diagnosis and the need for frenotomy
• Date of the procedure
• Details of the procedure, including the incision made in the labial frenum
• Any additional services provided on the same day, if applicable

7. Billing guidelines

When billing for CPT 40806, ensure that the procedure meets the criteria for this code. It is important to note that modifier 25, which indicates a significant, separately identifiable evaluation and management service, may be appended to the appropriate E/M code if an evaluation was performed on the same day as the frenotomy.

8. Historical information

CPT 40806 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A dentist performs a frenotomy to release a tight labial frenum in a patient with a gap between their front teeth.
2. An oral surgeon makes an incision in the labial frenum to release a tight frenum and its surrounding tissues in a patient with gum problems.
3. A pediatric dentist performs a frenotomy to release a tight labial frenum in a child with difficulty breastfeeding.
4. An orthodontist makes an incision in the labial frenum to release a tight frenum and improve the movement of the upper lip in a patient undergoing orthodontic treatment.
5. A maxillofacial surgeon performs a frenotomy to release a tight labial frenum in a patient with speech difficulties.
6. A periodontist makes an incision in the labial frenum to release a tight frenum and improve oral hygiene in a patient with gum disease.
7. An oral and maxillofacial surgeon performs a frenotomy to release a tight labial frenum in a patient with difficulty wearing dentures.
8. A general dentist makes an incision in the labial frenum to release a tight frenum and improve the fit of a dental prosthesis in a patient.
9. An oral surgeon performs a frenotomy to release a tight labial frenum in a patient with a tongue-tie.
10. A pediatric dentist makes an incision in the labial frenum to release a tight frenum and improve the appearance of the patient’s smile.