2025 CPT code 49600
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Surgery - Hernia repair Surgery Feed
Repair of a small omphalocele using primary closure.
Modifiers 22, 51, 52, 53, 54, 55, 56, 58, 62, 73, 74, 76, 77, 78, 79, 80, 81, 82, 99 may be applicable depending on the circumstances of the procedure and as per the official CPT guidelines. Modifier 50 is used for bilateral procedures, except those in the range 49591-49622.
Medical necessity for repair of an omphalocele is established based on the size of the defect, the presence of complications (such as strangulation or incarceration), and the potential for future complications such as bowel obstruction or hernia recurrence. Repair is usually recommended in most cases.
The surgeon is responsible for all aspects of the procedure, from pre-operative assessment and preparation to post-operative care and follow-up.
- Surgery
- Hernia repair codes, categorized by hernia type (omphalocele), further categorized as initial repair.
In simple words: The doctor repairs a small omphalocele, a birth defect where abdominal organs protrude through an opening in the belly button, covered by a thin membrane. They stitch the opening closed.
This CPT code encompasses the surgical repair of a small omphalocele involving primary closure. The procedure includes an incision over the defect, dissection of the peritoneal sac, identification of the omphalocele, resection of the membrane, reduction of abdominal contents back into the peritoneal cavity, and closure of the defect with sutures.The surgeon also checks for bleeding and closes the incision.
Example 1: A newborn infant presents with a small omphalocele. The surgeon performs a primary closure, reducing the herniated contents and closing the abdominal wall defect., A small omphalocele is identified during a routine postnatal examination.The surgeon performs an elective repair with primary closure under general anesthesia., An infant is born with a small omphalocele that is asymptomatic. The parents elect for surgical repair, and the surgeon performs a primary closure of the defect.
Preoperative assessment including size and content of the omphalocele, intraoperative findings, type of closure (primary), and postoperative course. Imaging studies (ultrasound) may be required pre-operatively.
** Always confirm the size of the omphalocele to ensure correct code selection.Consider using other codes if the omphalocele is large or if a prosthetic material is used.
- Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
- RVU: Refer to the CMS national physician fee schedule for current relative value units (RVUs) and reimbursement rates.
- Global Days: The global period for this procedure needs to be determined based on the payer's specific guidelines and local coverage determinations.
- Payment Status: Active
- Modifier TC rule: TC modifier is generally not applicable to this code as the procedure is typically performed by the surgeon.
- Fee Schedule: Fee schedules vary by payer and location.Refer to historical payer fee schedules and CMS data for past reimbursement rates.
- Specialties:General Surgery, Pediatric Surgery
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center