How To Use CPT Code 40812

CPT 40812 describes the excision of a lesion or area of damaged or diseased tissue in the mucosa and submucosa of the vestibule of the mouth, followed by a simple repair. 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 40812?

CPT 40812 is used to describe the excision of a lesion or area of damaged or diseased tissue in the mucosa and submucosa of the vestibule of the mouth, along with a simple repair. This code is used when a provider removes the affected tissue and closes the wound using one layer of simple, interrupted sutures.

2. Official Description

The official description of CPT code 40812 is: ‘Excision of lesion of mucosa and submucosa, vestibule of mouth; with simple repair.’

3. Procedure

1. The provider prepares the patient by administering anesthesia and prepping the affected area.
2. Using a scalpel or needle-tipped electrocautery, the provider makes an incision in the mucosa and/or submucosa of the vestibule of the mouth.
3. The provider removes the lesion along with its margins.
4. The provider then closes the wound using one layer of simple, interrupted sutures.

4. Qualifying circumstances

CPT 40812 is performed when there is a need to excise a lesion or area of damaged or diseased tissue in the mucosa and submucosa of the vestibule of the mouth. This procedure is typically done to remove cysts, nodules, or other abnormal tissue. The lesion must be located in the gingivobuccal groove, which is the space between the lips and the teeth. The procedure requires a simple repair of the surgical wound.

5. When to use CPT code 40812

CPT code 40812 should be used when a provider performs an excision of a lesion or area of damaged or diseased tissue in the mucosa and submucosa of the vestibule of the mouth, followed by a simple repair. This code should not be used for complex repairs or when excision of underlying muscle is involved.

6. Documentation requirements

To support a claim for CPT 40812, the provider must document the following information:

• Patient’s diagnosis and the need for excision of the lesion
• Specific location of the lesion in the vestibule of the mouth
• Details of the procedure, including the use of anesthesia and the type of instrument used for incision
• Description of the lesion and its margins
• Details of the simple repair, including the use of one layer of simple, interrupted sutures
• Any additional relevant information, such as the use of electrocautery or other techniques

7. Billing guidelines

When billing for CPT 40812, ensure that the procedure involves the excision of a lesion in the mucosa and submucosa of the vestibule of the mouth, followed by a simple repair. It is important to accurately document the details of the procedure and provide the necessary supporting documentation. CPT code 40812 should not be reported with codes 40814 or 40816, which involve complex repairs or excision of underlying muscle.

8. Historical information

CPT 40812 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 performs an excision of a cyst in the mucosa and submucosa of the vestibule of the mouth, followed by a simple repair.
2. A patient presents with a nodule in the gingivobuccal groove, and the provider performs an excision of the lesion and closes the wound with one layer of simple, interrupted sutures.
3. A provider removes an abnormal tissue in the mucosa and submucosa of the vestibule of the mouth, and performs a simple repair to close the wound.
4. A lesion is identified in the vestibule of the mouth, and the provider excises the affected tissue and performs a simple repair.
5. A patient undergoes an excision of a neuroma in the mucosa and submucosa of the vestibule of the mouth, followed by a simple repair.
6. A provider removes a cyst in the gingivobuccal groove and performs a simple repair to close the wound.
7. An abnormal tissue is identified in the mucosa and submucosa of the vestibule of the mouth, and the provider performs an excision and a simple repair.
8. A patient presents with a nodule in the vestibule of the mouth, and the provider excises the lesion and performs a simple repair.
9. A provider removes an abnormal tissue in the mucosa and submucosa of the vestibule of the mouth, and performs a simple repair to close the wound.
10. A lesion is identified in the gingivobuccal groove, and the provider excises the affected tissue and performs a simple repair.