2025 CPT code 49610
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Surgery - Hernia repair Surgery Feed
First stage of omphalocele repair (Gross type operation).
Modifiers may apply depending on the specific circumstances of the procedure.For example, modifier 50 (bilateral procedure) is not applicable for code 49610. Refer to current CPT guidelines and NCCI edits for the most current information.
Medical necessity for omphalocele repair is established by the presence of a congenital defect in the abdominal wall, the extent of the defect, and the risk to the patient. The size and complexity of the omphalocele usually dictate whether a staged or primary repair is medically necessary.
The surgeon is responsible for performing the initial surgical steps of omphalocele repair, which includes creating and suturing skin flaps to cover the omphalocele defect.Postoperative care might also be a part of the surgical team's responsibility.
In simple words: This code describes the first part of a two-part surgery to fix an omphalocele (a birth defect where the baby's intestines stick out of the belly button). In this first stage, the doctor creates a flap of skin to cover the defect and stitches it closed.A second surgery is needed later to put the organs back inside the belly.
This CPT code, 49610, represents the first stage of a Gross-type operation for omphalocele repair.The procedure involves raising skin flaps to cover the omphalocele, effectively creating an incisional hernia, followed by suturing the skin flaps. The second stage, involving the insertion of the abdominal contents, is coded separately using 49611.
Example 1: A newborn with a small omphalocele undergoes the first stage of the Gross procedure. The surgeon raises skin flaps, covers the omphalocele sac, and sutures the skin., A neonate with a large omphalocele requires a staged repair.The first stage (49610) is performed to protect the contents of the omphalocele and prepare for the second stage., A premature infant presents with an omphalocele. The surgical team performs the first stage of repair, 49610, in preparation for the subsequent reduction of the abdominal contents.
Preoperative assessment including imaging, operative report detailing the techniques used, size and location of the defect, type of closure, and any complications. Postoperative notes should document the patient's progress and any complications.
** This code is specific to the first stage of a two-stage omphalocele repair using the Gross technique. The second stage (CPT 49611) must be billed separately. The size of the omphalocele influences the surgical approach and the necessity of a staged versus primary repair.
- Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
- RVU: This information requires access to a specific fee schedule and may vary by payer and location. RVUs are not explicitly available in the provided data.
- Global Days: The global period for this procedure would depend on the specifics of the surgery and the surgeon's practice, additional data required.
- Payment Status: Active
- Modifier TC rule: No information is available from the source regarding the application of a Technical Component (TC) modifier. Further clarification is needed from other resources.
- Fee Schedule: Fee schedules vary significantly across payers and geographic regions. Historical fee schedule data is not provided in the source.
- Specialties:Pediatric Surgery, General Surgery, Neonatal Surgery
- Place of Service:Inpatient Hospital