| Section | 0 | Medical and Surgical |
| Body System | C | Mouth and Throat |
| Operation | 0 | Alteration: Modifying the anatomic structure of a body part without affecting the function of the body part |
| Body Part 0 Upper Lip 1 Lower Lip |
Approach X External |
Device 7 Autologous Tissue Substitute J Synthetic Substitute K Nonautologous Tissue Substitute Z No Device |
Qualifier Z No Qualifier |