How To Use CPT Code 40814

CPT 40814 describes 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 complex 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 40814?

CPT 40814 can be 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 complex repair. This code is used when the provider removes the lesion and its margins, and then closes the incision with sutures. The depth of excision may require deeper, complex sutures, rearrangement of tissue, or tissue flaps.

2. Official Description

The official description of CPT code 40814 is: ‘Excision of lesion of mucosa and submucosa, vestibule of mouth; with complex repair.’

3. Procedure

1. The provider prepares the patient and administers anesthesia.
2. Using a scalpel or needle-tipped electrocautery, the provider incises the lesion in the mucosa and/or submucosa of the vestibule of the mouth.
3. The provider removes the lesion and its margins.
4. The provider closes the incision with sutures, which may involve deeper, complex sutures, rearrangement of tissue, or tissue flaps depending on the depth of the excision.

4. Qualifying circumstances

Patients eligible for CPT 40814 are those with a lesion or area of damaged or diseased tissue in the mucosa and submucosa of the vestibule of the mouth that requires excision and complex repair. The procedure is performed by a qualified provider who has the necessary skills and expertise to perform the excision and complex repair.

5. When to use CPT code 40814

CPT code 40814 should be used when a provider performs 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 complex repair. This code should be used for each instance of excision and complex repair performed.

6. Documentation requirements

To support a claim for CPT 40814, the provider must document the following information:

• Patient’s diagnosis and the need for excision and complex repair
• Details of the procedure, including the specific lesion or area of tissue excised
• Method of excision (scalpel or needle-tipped electrocautery)
• Details of the complex repair, including any deeper sutures, tissue rearrangement, or tissue flaps
• Date of the procedure
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 40814, ensure that the procedure is performed by a qualified provider and includes both the excision of the lesion or area of tissue and the complex repair. There are no specific guidelines regarding reporting CPT 40814 with other codes. However, it is important to follow any applicable bundling or unbundling rules and guidelines provided by payers.

8. Historical information

CPT 40814 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 the excision of a lesion in the mucosa and submucosa of the vestibule of the mouth, along with complex repair, for a patient with a benign tumor.
2. A provider excises a lesion in the mucosa and submucosa of the vestibule of the mouth, along with complex repair, for a patient with a nodule.
3. A provider performs the excision of a lesion in the mucosa and submucosa of the vestibule of the mouth, along with complex repair, for a patient with a neuroma.
4. A provider excises a lesion in the mucosa and submucosa of the vestibule of the mouth, along with complex repair, for a patient with a cyst.
5. A provider performs the excision of a lesion in the mucosa and submucosa of the vestibule of the mouth, along with complex repair, for a patient with a malignant tumor.
6. A provider excises a lesion in the mucosa and submucosa of the vestibule of the mouth, along with complex repair, for a patient with a lesion requiring deeper sutures.
7. A provider performs the excision of a lesion in the mucosa and submucosa of the vestibule of the mouth, along with complex repair, for a patient with a lesion requiring tissue rearrangement.
8. A provider excises a lesion in the mucosa and submucosa of the vestibule of the mouth, along with complex repair, for a patient with a lesion requiring tissue flaps.
9. A provider performs the excision of a lesion in the mucosa and submucosa of the vestibule of the mouth, along with complex repair, for a patient with a lesion requiring rearrangement of tissue and tissue flaps.
10. A provider excises a lesion in the mucosa and submucosa of the vestibule of the mouth, along with complex repair, for a patient with a lesion requiring deeper sutures and tissue flaps.