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davidkerr
#1 Posted : Wednesday, January 18, 2017 12:20:25 PM(UTC)
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davidkerr

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Removed a 8mm fibroma on the corner of a patient's lips, was denied coverage by dental insurance. Would love input on codes including diagnosis and procedural. We are a general dental office and the removal was done via diode laser.
courtneydsnow
#2 Posted : Thursday, January 19, 2017 8:21:03 AM(UTC)
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courtneydsnow

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Hi davidkerr!

No problem, here are some CPT coding options based on what you described below:

11441 - excision benign lesion 0.6 to 1.0 cm
40810 - Excision of lesion of mucosa and submucosa, vestibule of mouth without repair
40812 - Excision of lesion of mucosa and submucosa, vestibule of mouth with simple repair

And here are some ICD-10 diagnosis coding options for you:

D37.01 - Neoplasm of uncertain behavior of lip
D10.0 - Benign neoplasm of lip
D23.0 - Other benign neoplasm of skin of lip
C00.0 - Malignant neoplasm of external upper lip
C00.1 - Malignant neoplasm of external lower lip
C00.2 - Malignant neoplasm of external lip, unspecified
C00.3 - Malignant neoplasm of upper lip, inner aspect
C00.4 - Malignant neoplasm of lower lip, inner aspect
C00.5 - Malignant neoplasm of lip, unspecified, inner aspect
C00.6 - Malignant neoplasm of commissure of lip, unspecified
C00.8 - Malignant neoplasm of overlapping sites of lip
C00.9 - Malignant neoplasm of lip, unspecified

Hope this helps, have a great day!
Jenny
#3 Posted : Monday, February 17, 2020 5:26:17 PM(UTC)
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I submitted a medical claim for this exact situation, however the insurance told me that these codes 40810-40816 are no longer used and I should use 41110-41114. I'm confused as they are different procedures and descriptions. We in fact did a 40812 but insurance will not pay this. Is there a more appropriate code for excisional biopsy of lesion on lower right lip (Irritation Fibroma, Lipoma)?

Thank you for your insight!
courtneydsnow
#4 Posted : Tuesday, February 18, 2020 12:33:38 PM(UTC)
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courtneydsnow

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Hi Jenny!

Hm that is interesting, i do show that 40810-40816 are currently active/valid CPT codes....

40812 stands for: Excision of lesion of mucosa and submucosa, vestibule of mouth; with simple repair

4110-41114 are as follows:

41110 - Excision of lesion of tongue without closure
41112 - Excision of lesion of tongue with closure; anterior two-thirds
41113 - Excision of lesion of tongue with closure; posterior one-third
41114 - Excision of lesion of tongue with closure; with local tongue flap

For biopsy of the lip or excision of lesion of the lip, you may consider:

40490 - Biopsy of lip
11440 - Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.5 cm or less
11441 - Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.6 to 1.0 cm
11442 - Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 1.1 to 2.0 cm
11443 - Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 2.1 to 3.0 cm
11444 - Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 3.1 to 4.0 cm
11446 - Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm



Hope this helps!
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