Summary & Overview
CPT 40652: Full-Thickness Lip Tear Closure, Up to Half Vertical Height
CPT code 40652 defines the surgical repair of a full–thickness lip tear up to half the vertical height, using sutures. This code captures a common, focused soft-tissue procedure performed for traumatic or surgically created lip wounds that involve the mucosa, muscle, and skin across the full thickness of the lip. Nationally, accurate use of this CPT code matters for consistent clinical documentation, correct procedure assignment, and appropriate billing across emergency departments, outpatient clinics, and ambulatory surgical centers.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines coding benchmarks, typical sites of service, clinical context for appropriate application, and common modifiers and coding considerations. Readers will find guidance on distinguishing this specific full–thickness closure from other lip repair codes based on tear depth and vertical height, an overview of expected clinical settings, and a summary of documentation elements that support code selection.
This summary is intended for national audiences including clinicians, coding professionals, and revenue cycle staff seeking a concise reference to CPT code 40652 and its clinical and billing context. Data not available in the input is noted where applicable in detailed sections.
Billing Code Overview
CPT code 40652 describes surgical closure of a full–thickness lip tear measuring up to half the vertical height of the lip using sutures. The procedure applies to traumatic lip lacerations or wounds created surgically that involve the entire thickness of the lip tissue but are limited in vertical extent.
Service type: Surgical repair / minor oral soft tissue surgery
Typical site of service: Emergency department, ambulatory surgical center, or outpatient clinic procedure room, depending on clinical context and acuity.
Clinical & Coding Specifications
Clinical Context
A 28-year-old patient presents to the emergency department after sustaining a facial laceration from a bicycle accident. Examination reveals a full-thickness vertical tear of the vermilion border of the lower lip measuring approximately 8 mm (up to half the vertical height of the lip). The wound involves mucosa, muscle, and skin with some irregularity of the vermilion border but without significant avulsion of tissue. The patient is otherwise healthy, tetanus status up to date, and has no active bleeding disorders.
The clinical workflow includes triage evaluation, cleansing and local anesthetic infiltration (or procedural sedation if required), assessment and irrigation of the wound, precise realignment of the vermilion border, layered closure with absorbable sutures for the mucosa and muscle and nonabsorbable or fine monofilament sutures for the skin/lip margin, hemostasis, and application of topical antibiotic ointment and dressings. The procedure is documented as repair of a full-thickness lip laceration up to half the vertical height using technique, suture sizes, and number of layers. Postprocedure instructions include wound care, signs of infection, and timeline for suture removal and follow-up for cosmetic assessment.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Service performed by the operating physician | When the primary surgeon performed the repair and this indicates the usual or normal service |