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The CPT® Code 49605 refers to the surgical procedure for the repair of a large omphalocele or gastroschisis, which are congenital defects involving the abdominal wall. An omphalocele is characterized by a large umbilical ring defect where internal organs, including the bowel, are located outside the abdomen, covered by a thin membrane. In contrast, gastroschisis involves a defect located to the side of the umbilicus, where the bowel and other organs protrude without a protective membrane. This procedure is critical for restoring the integrity of the abdominal wall and ensuring that the internal organs are properly positioned within the abdominal cavity. The physician may employ one of two primary techniques during the repair. The first technique involves directly closing the defect without the use of a prosthesis, utilizing manual manipulation to stretch the abdominal wall and accommodate the internal organs. The second technique involves the use of a prosthetic silo or pouch, which allows for a gradual reduction of the herniated organs into the abdomen over time. This procedure is essential for preventing complications associated with these congenital defects and facilitating normal abdominal function and development in affected infants.
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The procedure coded as CPT® 49605 is indicated for the surgical repair of large omphaloceles or gastroschisis. These conditions are typically present at birth and require intervention to prevent complications such as infection, bowel obstruction, or damage to the internal organs. The following are specific indications for performing this procedure:
The procedure for CPT® 49605 involves several critical steps to ensure the successful repair of the abdominal wall defect. The following outlines the procedural steps:
After the completion of the procedure coded as CPT® 49605, the patient will require careful monitoring and post-operative care. This includes assessing the surgical site for signs of infection, ensuring proper healing of the abdominal wall, and monitoring the function of the internal organs. The recovery process may vary depending on the technique used and the individual patient's condition. Follow-up appointments will be necessary to evaluate the success of the repair and to address any complications that may arise. Additionally, parents or caregivers will receive instructions on caring for the surgical site and recognizing any signs of distress or complications in the infant.
| Short Descr | REPAIR UMBILICAL LESION | Medium Descr | RPR LG OMPHALOCELE/GASTROSCHISIS W/WO PROSTH | Long Descr | Repair of large omphalocele or gastroschisis; with or without prosthesis | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 86 - Other hernia repair |
This is a primary code that can be used with these additional add-on codes.
| 49623 | Add-on Code Resequenced Code MPFS Status: Active Code APC N Removal of total or near total non-infected mesh or other prosthesis at the time of initial or recurrent anterior abdominal hernia repair or parastomal hernia repair, any approach (ie, open, laparoscopic, robotic) (List separately in addition to code for primary procedure) |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | LT | Left side (used to identify procedures performed on the left side of the body) |
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| Pre-1990 | Added | Code added. |
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