2025 CPT code 49611
(Active) Effective Date: N/A Revision Date: N/A Surgical Procedures on the Digestive System - Hernia repair Surgery Feed
Repair of omphalocele (Gross type operation); second stage.
Modifiers may be applicable depending on the circumstances of the procedure. Review NCCI guidelines and payer specific requirements for accurate modifier use. Modifier 50 can be used for bilateral procedures but only under certain circumstances. Modifier 22 can be used to indicate increased procedural services.
Surgical repair of an omphalocele is medically necessary to protect the abdominal contents from injury, infection, and dehydration, and to facilitate normal growth and development.The specific medical necessity would be documented in the patient's medical record and should support the need for the second-stage closure.
The surgeon is responsible for all aspects of the procedure, from preoperative assessment and planning to the postoperative care.This includes meticulous dissection, reduction of abdominal contents, and careful closure of the abdominal wall to minimize complications.
- Surgery
- Hernia repair codes, categorized by hernia type (omphalocele), and further by initial vs. recurrent repair.
In simple words: This code describes the second part of a two-part surgery to fix an omphalocele, a birth defect where the baby's belly button area isn't fully closed.The surgeon repairs the defect, putting the organs back inside the belly and closing the incision.
This CPT code, 49611, represents the second stage of a Gross-type operation to repair an omphalocele, a congenital abdominal wall defect.The procedure involves inspecting the previously closed area (from the first stage, 49610), incising the skin flaps, dividing any adhesions, reducing the abdominal contents back into the abdominal cavity, closing the abdominal wall, and finally closing the abdominal incision. This is typically performed on infants.
Example 1: A newborn infant is diagnosed with an omphalocele requiring a staged surgical repair.The first stage (49610) is performed to protect the abdominal contents.After several weeks of growth and stabilization, the second stage (49611) is completed to close the abdominal wall defect., A premature infant presents with a large omphalocele and associated bowel necrosis.In addition to 49611, the surgeon reports codes for the resection of the necrotic bowel and any other necessary procedures., An infant with an omphalocele undergoes the second-stage repair.Significant adhesions are encountered, necessitating additional operative time and effort to safely reduce the abdominal contents.
Complete operative notes detailing the procedure, including the size and characteristics of the omphalocele, presence of adhesions, condition of abdominal contents, technique used, and postoperative course.Preoperative imaging (e.g., ultrasound) may also be necessary, particularly if bowel necrosis is suspected.
** This code is specific to the second stage of a Gross-type omphalocele repair.The first stage is coded separately (49610).Careful documentation is critical for accurate coding and reimbursement.Always consult the most recent CPT and payer-specific guidelines for accurate coding practices.
- Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
- RVU: This information requires access to specific fee schedules and may vary based on location, payer, and other factors.Consult relevant fee schedules for RVU data.
- Global Days: The global period for this procedure is not explicitly defined in the provided data.Further information from specific payer guidelines or fee schedules is needed.
- Payment Status: Active
- Modifier TC rule: The application of a Technical Component (TC) modifier to 49611 would depend on the specific circumstances of the service provision and payer requirements.Further clarification may be required depending on the payment scenario.
- Fee Schedule: Historical fee schedule information is not available in the provided data. Consult payer-specific fee schedules and historical data for relevant information.
- Specialties:General Surgery, Pediatric Surgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center