Otolaryngology Coding Alert

Focus on type of laceration, vermillion border for correct code set.

Coding wound repairs of the lips offers coders an additional degree of difficulty as compared to wound repairs of other sites of the face. That’s because coders must distinguish not only between intermediate and complex repairs, but whether or not the repair includes a portion of the lip known as the vermillion border.

If that’s not enough, you’ve also got to have a grasp on how the nature of the laceration may play a role in determining the code. Dissecting a complex lip repair operative note is rarely easy, but there are tools in place to help you confidently reach the correct CPT^® code.

Digest these two helpful clues to further build upon your lip repair coding skillset.

Tip 1: Determine Type of Laceration

Most complex repairs of the lips will involve either a full-thickness or “through and through” style laceration. Understanding how these terms compare and contrast is crucial in your attempt to reach the correct repair code.

“A through and through laceration is, simply put, a laceration that penetrates two surfaces of a given structure,” relays Barry Rosenberg, MD, chief of radiology at United Memorial Medical Center in Batavia, New York. “In the example of a through and through laceration of the lip, this means that the laceration penetrates the skin all the way through to the oral mucosa, or vice versa,” Rosenberg explains.

On the other hand, a full-thickness laceration involves a tear through the dermal layer into or through the subcutaneous tissue. Where things get complicated is that, technically, a full-thickness laceration also qualifies as a through and through laceration. Use code 40650 (Repair lip, full thickness; vermilion only) as an example.

In the 2004 Vol.4 Qtr.2 issue of the American Hospital Association (AHA) HCPCS Coding Clinic, the AHA states the following in response to a reader question:

• “Report code 40650 for the repair of the lip lacerations since the physician documented this as a through-and through-laceration. This repair involves all the layers of tissue of the lower lip (i.e. mucosa, submucosa, and subcutaneous tissue).”

As you can see, 40650 only references a “full thickness” laceration in the code description, yet the AHA states that the code is eligible for use when the surgeon repairs a through and through laceration. Therefore, you can deduce that a through and through laceration includes a full-thickness laceration. However, these are not interchangeable terms. A full-thickness laceration does not necessarily qualify as a through and through laceration unless it meets the criteria listed in the definition of a through and through laceration.

Disclaimer: You should utilize this reader question response specifically to understand that full-thickness and through and through lacerations are not mutually exclusive from one another. There is not enough information provided in this response to determine whether or not 40650 is actually the correct code for the clinical scenario presented.

Tip 2: Define Vermillion Border, Zone

The next important step in the coding process is making the distinction between two different wound repair code sets. Some coders may think that a focus on anatomical site for lip repairs isn’t necessarily important under the pretense that a wound repair of the lips either involves the lips, or it doesn’t.

However, there are two anatomical components of the lips in which those working outside of a related surgical specialty may not be aware of — the vermillion border and the vermillion zone.

The vermillion border, as defined by Stedman’s Medical Dictionary, is “the junction between the skin aspect of the lip and the vermilion zone.” In contrast, Stedman’s defines the vermillion zone as “the red margin of the upper and lower lip that commences at the exterior edge of the intraoral labial mucosa and extends outward, terminating at the extraoral labial cutaneous junction.” In much more simplified terms, you can think of the vermillion zone as encompassing the lips, and the vermillion border as the linear boundary between the lips and the skin of the face.

Clearly defining what constitutes the vermillion border isn’t always enough to lead you to the correct code set, though. Making a distinction between code sets 1205X (Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes…), 1315X (Repair, complex, eyelids, nose, ears and/or lips…), and 4065X (Repair lip, full thickness…) is no easy task. That’s in part due to the brief and somewhat ambiguous code descriptions found in the 4065X code set. Make sure to check out a future issue of Otolaryngology Coding Alert for a plethora of examples on how to properly code and differentiate between these troublesome code sets.