2025 CPT code 49606

Repair of large omphalocele or gastroschisis; with removal of prosthesis, final reduction and closure, in operating room.

Refer to the CPT guidelines for hernia repair codes.Specific considerations should be made for patient age and clinical presentation (reducible, incarcerated, strangulated). Appropriate codes for the repair of any strangulated organs should be reported in addition to 49606.

Modifiers 50 (bilateral procedure), 51 (multiple procedures), and others may be applicable depending on the circumstances of the surgical procedure and should be used according to the CPT guidelines.

Medical necessity is established by the presence of a large omphalocele or gastroschisis requiring surgical repair, especially when a previous prosthesis has failed or needs removal. The procedure is necessary to correct the congenital defect, prevent complications (infection, bowel obstruction), and improve the child’s quality of life.

The surgeon is responsible for pre-operative assessment, performing the surgery (including prosthesis removal, reduction of contents, abdominal wall repair, and possible umbilicus reconstruction), and post-operative care.

IMPORTANT For excision/repair of strangulated organs, use appropriate codes (e.g., 44120, 54520, 58940) in addition to the hernia repair code. For debridement of abdominal wall, use 11042 or 11043. For reduction and repair of intra-abdominal hernia, use 44050. Codes 49491-49557, 49600, 49605, 49606, 49610, 49611, 49650, 49651 are unilateral; use modifier 50 for bilateral procedures (except 49591-49622).

In simple words: This surgery fixes a large birth defect where the baby's intestines are outside the body (omphalocele or gastroschisis). The doctor removes a previous support, puts the intestines back inside, and closes the opening in the belly.

In an operating room setting, the surgical repair of a large omphalocele or gastroschisis involves the removal of a previously implanted prosthesis.The procedure continues with the reduction of the herniated abdominal contents back into the abdominal cavity, followed by the closure and repair of the abdominal wall defect.The surgeon may utilize skin flaps to reconstruct the umbilicus. The incision may be closed primarily for healing or left open for drainage, depending on the clinical circumstances.

Example 1: A newborn presents with a large omphalocele, and a prosthesis was placed previously. The surgeon performs 49606 to remove the prosthesis, reduce the contents, and close the abdominal wall defect., An infant with a gastroschisis requiring repair after a previous failed attempt.The initial prosthesis is removed, the intestines are repositioned, and the abdominal wall is repaired utilizing 49606., A child with a recurrent omphalocele following a prior repair.The surgeon removes the prior repair, reduces the herniated contents, and performs a definitive closure using code 49606.

Preoperative assessment, operative report detailing prosthesis removal, reduction technique, abdominal wall closure method, and post-operative course. Imaging studies (ultrasound, CT scan) may be required pre- and post-operatively. Pathology reports if any tissue is removed.

** This code is typically used for complex cases involving large omphaloceles or gastroschisis requiring significant surgical intervention.The size of the patient (infant) significantly affects reimbursement.Consult the most recent CPT manual for complete and up-to-date coding guidelines and any changes that might have occurred after 03 December 2024.

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