Who is the insurance company? I would argue that according to CMS, there are no CCI Edits pertaining to these two codes and they are using inappropriate bundling of these two services and demand a review by a Board Certified Otolaryngologist. Here is the Encoder's interpretation of CPT 40845:
40845
Vestibuloplasty; complex (including ridge extension, muscle repositioning)
Lay Description (Code):
The surgeon performs a vestibuloplasty and deepens the vestibule of the mouth by any series of surgical procedures for the purpose of increasing the height of the alveolar ridge, allowing a complete denture to be worn. The vestibule refers to the mucosal and submucosal tissue of the inner lips and cheeks, the part of the oral cavity outside of the dentoalveolar structures. This procedure is performed for complex cases, such as those in which the physician must lower muscle attachments to provide enough space for deepening the vestibule. Soft tissue grafting from other areas of the body into the mouth is often required. Hypertrophied and hyperplastic tissue may need to be trimmed and soft tissue revised by dissecting it from the alveolar ridge and rearranging its attachment.
Coding Tips
When 40845 is performed with another separately identifiable procedure, the highest dollar value code is listed as the primary procedure and subsequent procedures are appended with modifier 51. If significant additional time and effort is documented, append modifier 22 and submit a cover letter and operative report. Report any free grafts or flaps separately, see 15120, and 15240. Local anesthesia is included in the service. For anterior vestibuloplasty, see 40840. For posterior vestibuloplasty, unilateral, see 40842; bilateral, see 40843. For vestibuloplasty of the entire arch, see 40844.
Jennifer
IN ENT