How To Use CPT Code 49904

CPT 49904 describes the use of an omental flap, an extra-abdominal graft, for the reconstruction of sternal and chest wall defects. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 49904?

CPT 49904 can be used to describe the use of an omental flap, an extra-abdominal graft, for the reconstruction of sternal and chest wall defects. This code is used when a provider harvests and transfers the omental flap to fill a defect in the chest during reconstructive chest surgery, such as for a nonhealing wound. The omental flap is rotated into position without disrupting its vascular supply.

2. Official Description

The official description of CPT code 49904 is: ‘Omental flap, extra-abdominal (eg, for reconstruction of sternal and chest wall defects).’ The code includes both the harvest and transfer of the omental flap. If a second surgeon harvests the omental flap, both surgeons should code 49904 as co-surgeons using modifier 62.

3. Procedure

1. During reconstructive chest surgery, the provider makes a laparotomy incision to open up the abdomen.
2. The provider develops the omental flap, ensuring the preservation of its vascular attachments or pedicle.
3. The omental flap is rotated into position to fill the defect in the sternal or chest wall.
4. The provider sutures or staples the omental flap in place.
5. The provider closes the abdominal wound in layers.

4. Qualifying circumstances

CPT 49904 is used when the omental flap is harvested for use outside of the abdominal cavity, or extra-abdominally. It is typically performed during reconstructive chest surgery to repair sternal and chest wall defects, such as nonhealing wounds. The omental flap is still attached to its vascular supply in the abdomen through a pedicle, or stalk, and is positioned by rotating it into place. Modifier 62 should be used if a different provider harvests the omental graft than the one performing the primary procedure.

5. When to use CPT code 49904

CPT code 49904 should be used when the omental flap is harvested and transferred for the reconstruction of sternal and chest wall defects. It is appropriate when the procedure involves the use of an extra-abdominal omental flap and the defect is located in the chest area. This code should not be used for intraabdominal use of an omental flap, which requires reporting CPT code 49905.

6. Documentation requirements

To support a claim for CPT 49904, the provider must document the following information:

• Indication for the use of an omental flap for reconstruction of sternal and chest wall defects
• Details of the procedure, including the harvest and transfer of the omental flap
• Date of the procedure
• Any additional procedures performed during the same operative session
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 49904, ensure that the procedure involves the use of an extra-abdominal omental flap for the reconstruction of sternal and chest wall defects. Modifier 62 should be used if a different provider harvests the omental graft than the one performing the primary procedure. It is important to note that CPT code 49904 is an inpatient-only (IPO) code for Medicare patients.

8. Historical information

CPT 49904 was added to the Current Procedural Terminology system on January 1, 2003. In 2017, it was added to the Inpatient Only (IPO) list for Medicare patients.

9. Examples

1. A provider harvests and transfers an omental flap to reconstruct a sternal defect in a patient who has undergone cardiac surgery.
2. A provider uses an omental flap to repair a nonhealing wound on the chest wall of a patient who has had a previous thoracic surgery.
3. A provider performs reconstructive chest surgery and utilizes an omental flap to fill a defect in the chest wall caused by trauma.
4. A provider uses an omental flap to reconstruct a sternal defect in a patient who has undergone a sternotomy for cardiac surgery.
5. A provider harvests and transfers an omental flap to repair a chest wall defect in a patient with a history of radiation therapy.
6. A provider performs reconstructive chest surgery and utilizes an omental flap to fill a defect in the chest wall caused by infection.
7. A provider uses an omental flap to reconstruct a sternal defect in a patient with a nonhealing wound following a sternotomy.
8. A provider harvests and transfers an omental flap to repair a chest wall defect in a patient with a history of trauma.
9. A provider performs reconstructive chest surgery and utilizes an omental flap to fill a defect in the chest wall caused by tumor resection.
10. A provider uses an omental flap to reconstruct a sternal defect in a patient with a congenital chest wall deformity.