2025 CPT code 49906
(Active) Effective Date: N/A Surgery - Surgical Procedures on the Abdomen, Peritoneum, and Omentum Surgery Feed
Free omental flap with microvascular anastomosis. This includes the use of microsurgical techniques to perform the microvascular anastomosis.
Modifiers may be applicable to 49906 to indicate specific circumstances of the procedure, such as increased procedural services (modifier 22), multiple procedures (modifier 51), or reduced services (modifier 52).Appropriate modifier usage should be based on individual case circumstances.
Medical necessity for 49906 is established when a free omental flap is required for reconstruction due to tissue defects caused by trauma, surgery, infection, or congenital abnormalities.The documentation must support the need for this specific procedure over other reconstructive options.
The physician performs the harvesting of the free omental flap, its transfer, and microvascular anastomosis. This includes the abdominal laparotomy, meticulous dissection of the flap, severing its vascular connections, transferring the flap to the recipient site, and performing the microvascular anastomosis using an operating microscope and microsurgical techniques to ensure proper vascular supply. The surgeon also closes the abdominal incision.
In simple words: The surgeon takes a piece of tissue called the omentum from the abdomen and uses it as a graft to repair a defect in another part of the body, like the breast, head, neck, or limbs.This requires using a microscope and tiny instruments to reconnect blood vessels to the graft in the new location.
Harvesting of an omental flap as a free graft, detaching it from its abdominal location vessels. It is then used to fill defects during reconstructive surgery in other body areas (breast, head and neck, or extremities) using an operative microscope and microsurgical instruments to reconnect the vessels at the new location.The procedure involves laparotomy to access the abdomen, developing the omental flap, severing its vascular connections, positioning the free flap in the new location, using microsurgical techniques to connect arteries and veins to the flap for vascular support, securing it, and closing the abdominal wound.
Example 1: A patient with significant tissue defect in the breast following mastectomy requires reconstruction. A free omental flap is harvested and used to reconstruct the breast, providing adequate tissue coverage and restoring contour., A patient with severe head and neck trauma has a large soft tissue defect. A free omental flap is used to fill the defect and facilitate wound healing., A patient with a non-healing lower extremity wound requires soft tissue reconstruction. A free omental flap is harvested and used to cover the wound and promote healing.
Documentation should include the size and location of the defect, the reason for using a free omental flap, the operative technique including the microvascular anastomosis, and any complications encountered.
- Specialties:Plastic Surgery, Reconstructive Surgery, General Surgery, Head and Neck Surgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center