Summary & Overview
CPT 49606: Repair of Large Omphalocele or Gastroschisis, Prosthesis Removal
CPT code 49606 represents the surgical completion of repair for a large omphalocele or gastroschisis in an operating room setting, including removal of a previously placed prosthesis, reduction of abdominal contents, and closure of the defect. This code captures a complex reconstructive abdominal procedure most often performed by pediatric or general surgeons and is relevant nationally for billing, utilization tracking, and surgical quality assessment. Major payers in this context include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise clinical and billing overview, typical sites of service, and which payers are included in coverage comparisons. The publication also outlines common modifiers associated with the procedure and notes where input data are unavailable. The content is intended to support coding accuracy, payer conversations, and administrative planning for facilities that perform complex abdominal wall reconstructions. Policy and benchmark discussions focus on national implications for resource use, operative setting, and procedure classification rather than state-specific rules.
Billing Code Overview
CPT code 49606 describes the surgical completion of repair for a large omphalocele or gastroschisis performed in an operating room. The procedure involves removing a previously placed prosthesis, reducing the herniated abdominal contents back into the abdominal cavity, and closing the defect at the abdominal wall.
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Service type: Major abdominal reconstructive surgery
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Typical site of service: Operating room (inpatient or outpatient surgical facility)
Data not available in the input for payers, associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A full-term neonate with a previously managed large omphalocele (or gastroschisis) who underwent staged silo placement and temporary prosthetic coverage in the neonatal intensive care unit now returns to the operating room for definitive closure. The patient is transported to the operating room with stable vital signs under general endotracheal anesthesia. Preoperative review includes recent abdominal imaging, laboratory studies demonstrating adequate electrolytes and hematocrit, and surgical consent for removal of prosthesis, reduction of bowel and viscera into the peritoneal cavity, and fascial/skin closure. The operative team typically includes a pediatric surgeon, pediatric anesthesiologist, scrub and circulating nurses, and neonatal intensive care support. Intraoperative steps include sterile exposure of the abdominal wall defect, careful adhesiolysis as needed, removal of the previously placed prosthetic silo or patch, stepwise reduction of abdominal contents while monitoring ventilation and hemodynamics, assessment of intra-abdominal pressure, and multilayer closure of the fascia and skin. Hemostasis is confirmed and the wound is dressed; the neonate is recovered to the NICU or pediatric surgical ward for postoperative monitoring of respiratory status, abdominal compartment syndrome risk, fluid balance, and wound integrity.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Normal or routine service | Use when the service represents the physician's usual performance of the procedure without unusual circumstances. |