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A free omental flap is a surgical procedure that utilizes a portion of the greater omentum, which is a fold of peritoneum extending from the stomach and covering the intestines, to repair various types of defects in the body. The greater omentum is characterized by its unique vascular anatomy, featuring a dual blood supply that enhances its viability for reconstructive purposes. This flap consists of a rich network of blood vessels, adipose tissue, connective tissue, and immune cells, making it particularly effective for complex reconstructive surgeries. It is commonly employed in procedures aimed at repairing three-dimensional defects, such as those found in craniofacial and skull base reconstructions, as well as in scalp and head and neck repairs that may arise from tumor excisions, burns, hemifacial atrophy, or osteonecrosis due to radiation therapy. The procedure involves meticulous dissection and mobilization of the omentum, ensuring that the vascular supply is preserved for successful microvascular anastomosis, which is critical for the flap's survival and functionality in the recipient site.
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The free omental flap procedure is indicated for a variety of complex reconstructive needs, particularly in the following scenarios:
The procedure for harvesting a free omental flap involves several critical steps to ensure the successful transfer of the flap to the recipient site. The following outlines the procedural steps:
Post-procedure care following a free omental flap surgery involves monitoring for complications such as flap viability, infection, and hemostasis. Patients are typically observed for signs of adequate blood flow to the flap, which may include monitoring color, temperature, and capillary refill. Pain management is also an essential aspect of post-operative care. Patients may require follow-up visits to assess the healing process and the success of the flap integration at the recipient site. Standard post-operative care protocols, including wound care and activity restrictions, should be followed to promote optimal recovery.
| Short Descr | FREE OMENTAL FLAP MICROVASC | Medium Descr | FREE OMENTAL FLAP W/MICROVASCULAR ANAST | Long Descr | Free omental flap with microvascular anastomosis | Status Code | Carriers Price the 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) | 1 - Statutory payment restriction for assistants at surgery applies 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 | 99 - Other OR gastrointestinal therapeutic procedures |
| 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. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 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 | GW | Service not related to the hospice patient's terminal condition |
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| 2011-01-01 | Changed | Short description changed. |
| 1997-01-01 | Added | First appearance in code book in 1997. |
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