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The procedure described by CPT® Code 49606 involves the surgical repair of a significant abdominal wall defect known as an omphalocele or gastroschisis. An omphalocele is characterized by a large umbilical ring defect where internal organs, including the bowel, are located outside the abdominal cavity, covered by a thin membrane. In contrast, gastroschisis refers to a defect located to the side of the umbilicus, where the bowel and other organs are exposed without a protective membrane. This congenital condition necessitates surgical intervention shortly after birth to prevent complications such as infection or damage to the exposed organs. The repair can be performed using two primary techniques: one that closes the defect without the use of a prosthesis and another that involves the construction of a prosthetic silo or pouch to gradually accommodate the internal organs back into the abdominal cavity. The first technique involves manually stretching the abdominal wall to allow for the repositioning of the organs, while the second technique utilizes a prosthetic device to facilitate a gradual reduction of the defect over time. Once the organs are successfully contained within the abdomen, a follow-up procedure is conducted to remove the prosthesis and finalize the closure of the abdominal wall, ensuring that the skin is properly sutured to protect the internal structures.
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The procedure described by CPT® Code 49606 is indicated for the surgical repair of large omphaloceles or gastroschisis. These conditions are congenital defects that require intervention to prevent complications associated with the exposure of internal organs. The specific indications for this procedure include:
The surgical procedure for CPT® Code 49606 involves several critical steps to ensure the successful repair of the abdominal wall defect. The steps are as follows:
After the completion of the procedure, the patient is monitored for any signs of complications, such as infection or issues with the closure. Post-operative care may include pain management, monitoring of vital signs, and ensuring proper healing of the surgical site. The recovery period can vary depending on the complexity of the repair and the individual patient's condition. Follow-up appointments are essential to assess the healing process and to address any concerns that may arise during recovery.
| Short Descr | REPAIR UMBILICAL LESION | Medium Descr | RPR LG OMPHALOCELE/GASTROSCHISIS RMVL PROSTH | Long Descr | Repair of large omphalocele or gastroschisis; with removal of prosthesis, final reduction and closure, in operating room | 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) |
| 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 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. | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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| Pre-1990 | Added | Code added. |
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