49905: Open or Closed?

Question: In researching CPT® code 49905 Omental flap, intra-abdominal (List separately in addition to code for primary procedure), I found an article in AAPC’s Knowledge Center, dated 10/01/2013, titled “Omental Pedical Flaps,” that states this is an open surgical code. Does this mean I cannot this add-on code for laparoscopic procedures?
Answer: Code 49905 describes the use of a flap of omentum, a fatty membrane in the abdominal cavity, to fill a defect during an abdominal surgery. The surgeon rotates the flap into place, without disrupting its vascular supply.
Per CPT Assistant, November 2000 (Volume 10: Issue 11):

Question
We understand that code 49905 is an add-on code and must be used in addition to a primary procedure. The code descriptor reads “for repair of sternal or chest wall defects.” Does this mean that the flap cannot be used to repair other defects, such as defects left after total cystectomy with neobladder reconstruction?
AMA Comment
Code 49905, Omental flap (eg, for reconstruction of sternal and chest wall defects) (List separately in addition to code for primary procedure), is designated as an add-on code, so it would be reported in addition to the primary service or procedure and would never be reported as a stand-alone code. The portion of the code descriptor in the parentheses lists only examples. Code 49905 is not restricted to reconstruction of sternal and chest wall defects. It may be reported in addition to any primary procedure in which an omental flap is used. There is not a listing of primary procedure codes with which code 49905 may be reported.

The above CPT Assistant article is dated, and refers to 49905 using a since-revised descriptor; but, the final two sentences (emphasis added in the quote, above) indicate that there is no restriction to using this code only in addition to open procedures. Absent CPT®, Centers for Medicare & Medicaid Services (CMS), or payer instruction to the contrary, the CPT Assistant reference supports the use of 49905 “…in addition to any primary procedure in which an Omental flap is used” [emphasis added].

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John Verhovshek

John Verhovshek, MA, CPC, is a contributing editor at AAPC. He has been covering medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University.

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