👄 Full-Thickness Lip Laceration Repair CPT Guidelines: 40650, 40652, and 40654

Lip injuries are high-stakes repairs because of their cosmetic impact and functional importance in speech, eating, and expression. While many lip cuts can be coded using general wound repair codes (120xx, 131xx), the 4065x CPT series is reserved for full-thickness lip repairs — meaning the laceration involves skin, muscle, and mucosa.

1. Key Considerations in Lip Laceration Repair

Full-thickness definition: The laceration extends through skin, orbicularis oris muscle, and mucosa.
Vermilion border alignment: Even 1 mm misalignment can cause a visible cosmetic defect.
Extent of involvement: Vertical height and horizontal spread determine code selection.
Documentation must include: depth, layers repaired, vermilion border involvement, % of vertical lip height.

2. CPT Codes for Full-Thickness Lip Repairs

CPT 40650 — Repair, lip, full-thickness; vermilion only

Used for through-and-through lacerations limited to the vermilion (red lip) without extension into cutaneous skin.
Includes closure of mucosa and muscle beneath.
Example: 1.8 cm full-thickness laceration confined to the upper vermilion → 40650.

CPT 40652 — Repair, lip, full-thickness; up to one-half vertical height

Used when the laceration crosses the vermilion border into cutaneous lip skin, and involves up to one-half of the vertical height of the lip.
Requires layered closure of skin, muscle, and mucosa.
Example: 3 cm laceration crossing vermilion into skin, ~40% vertical lip height → 40652.

CPT 40654 — Repair, lip, full-thickness; over one-half vertical height (or complex)

Used for extensive through-and-through injuries involving more than half the vertical height of the lip or requiring complex reconstructive techniques.
Often involves avulsions or near-complete lip transections.
Example: 5 cm lower lip avulsion involving ~75% vertical height and both skin + mucosa → 40654.

3. Documentation Tips

To support proper code selection, document:

Exact length (cm) of the laceration.
Percentage of vertical lip height involved.
Whether the laceration was limited to vermilion vs extended into cutaneous skin.
Closure method: layered, undermining, cosmetic precision.
Any complicating factors: contamination (animal bites), bleeding, debridement.

4. Coding Scenarios

Scenario 1: 2 cm through-and-through laceration confined to vermilion only → 40650
Scenario 2: 3.5 cm full-thickness laceration crossing vermilion border into cutaneous lip, ~45% vertical lip height → 40652
Scenario 3: 6 cm avulsion-type laceration involving >60% vertical height of lower lip → 40654

5. Key Coding Reminders

40650–40654 override general wound repair codes (120xx, 131xx) for lip full-thickness repairs — don’t double-bill.
40650 is only for vermilion-only full-thickness repairs.
40652 vs 40654 depends on vertical height involved (<50% vs >50%).
Global period: 90 days — important for billing and follow-up planning.

✅ Summary

40650: Full-thickness lip repair, vermilion only
40652: Full-thickness lip repair, up to half vertical height (crosses vermilion into skin)
40654: Full-thickness lip repair, > half vertical height or complex reconstruction

Correct CPT selection depends on precise operative documentation of wound extent and repair technique.

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