Crystal's Coder Hub🧬 CPT 49255 — Omentectomy, Epiploectomy, Resection Of Omentum (Separate Procedure)
Quick Reference
wRVU: 12.56 | Global Period: 090 (90 days) | Assistant Payable: ✅ Yes | Bilateral Indicator: 0
📋 Clinical Description
CPT 49255 describes the surgical removal (resection) of the omentum—a large, apron-like fold of visceral peritoneum that hangs down from the stomach and covers the intestines. The surgeon performs this via an open abdominal incision (laparotomy), identifying the omentum, dissecting its vascular attachments (such as the gastroepiploic vessels), and excising the diseased or malignant tissue. Because the code is designated as a (separate procedure), it is intended to be reported only when the omentectomy is performed independently or is completely unrelated to another major abdominal procedure performed at the same session.
Omental pathology often occurs secondary to other intra-abdominal diseases. The omentum is a frequent site for metastatic cancer spread (particularly from ovarian, gastric, or colorectal origins). It can also suffer from isolated acute conditions such as omental torsion or infarction, where the tissue twists and loses its blood supply, resulting in tissue death and acute abdominal pain.
This procedure may be performed in the following clinical contexts:
- Primary or Metastatic Malignancy — To debulk tumor burden or stage cancers that have seeded into the peritoneal cavity (e.g., C78.6).
- Omental Infarction or Torsion — Removal of necrotic omental tissue causing an acute surgical abdomen (e.g., K55.069 or K56.2).
- Severe Endometriosis — When deep infiltrating endometriotic implants heavily involve the omentum, causing pain and requiring resection.
- Infection / Abscess — Removal of severely infected omental tissue that cannot be resolved with antibiotics or simple drainage.
🔬 Anatomical & Procedural Considerations
| Modality / Technique | Mechanism / Steps | Key Notes / Coding Impact |
|---|---|---|
| Open Abdominal Approach (Laparotomy) | A midline or subcostal incision is made. The stomach and transverse colon are retracted to expose the greater omentum, which is then excised using electrocautery or surgical staplers. | Mandatory for 49255. This code represents an open procedure. It cannot be used if the omentectomy is performed laparoscopically. |
| Partial vs. Total Omentectomy | The surgeon may remove a wedge/portion of the omentum (excision) or the entire apron (resection). | CPT 49255 encompasses both partial and total omentectomies. Do not bill multiple units if multiple pieces are removed. |
Clinical Pearl
The “Separate Procedure” Rule: In CPT nomenclature, the phrase (separate procedure) does not mean the code should be billed separately. It means the exact opposite. It signifies that the procedure is considered an integral component of any other major surgical procedure performed in the same anatomical area. You should only code 49255 if the omentectomy is the only procedure performed, or if it is performed for a distinctly separate, unrelated diagnosis through a separate incision (which is extremely rare). Never append modifier -59 to bypass an NCCI edit for 49255 just to gain extra reimbursement if the omentectomy was part of a broader resection for the same disease process.
✅ Procedure Includes
- Routine pre-operative evaluation in the holding area
- The primary open surgical incision (laparotomy) and abdominal exploration
- Isolation, ligation, and division of the omental vascular supply (gastroepiploic vessels)
- Excision or complete resection of the omentum (epiploectomy)
- Intraoperative hemostasis
- Closure of the abdominal wall and routine immediate postoperative care
❌ Excludes / Do Not Report Together
| Code | Description | Relationship to 49255 |
|---|---|---|
| 49329 | Unlisted laparoscopy procedure, abdomen, peritoneum and omentum | Modality mismatch. If the omentectomy is performed entirely via a laparoscope, you must report the unlisted laparoscopic code (49329). CPT 49255 is strictly an open procedure. |
| 58950 | Resection of ovarian, tubal or primary peritoneal malignancy with bilateral salpingo-oophorectomy and omentectomy | Subsumes 49255. Many gynecologic oncology codes explicitly include omentectomy in their definitions. When using these comprehensive codes, 49255 cannot be billed. |
| 58150 | Total abdominal hysterectomy (TAH) | Mutually Exclusive. NCCI edits bundle 49255 into 58150. Routine removal of the omentum during a TAH for benign disease is not separately billable. |
| 44140 | Colectomy, partial; with anastomosis | Bundled. Omentectomy is considered a standard component of major bowel resections when performed for the same pathology. |
Bundling Alert — Global Period is 090, Not 000
As a major open abdominal surgery, CPT 49255 carries a 90-day global period. All routine post-operative care within 90 days of the procedure is bundled into the surgical payment. If the patient is seen for an unrelated condition during this 90-day window, the E/M visit must be appended with modifier -24, and the documentation must explicitly state why the visit is independent of the surgery.
🌳 Code Tree — Surgery: Digestive System
CPT 40490-49999 Surgery: Digestive System
│
├── 49000-49999 Abdomen, Peritoneum, and Omentum
│ ├── 49000-49084 Incision Procedures
│ ├── 49180-49255 Excision and Destruction Procedures
│ │ ├── 49203 Excision or destruction, open, intra-abdominal tumors, cysts or endometriomas, < 5 cm (Global: 090)
│ │ ├── 49204 Excision or destruction, open, intra-abdominal tumors, cysts or endometriomas, 5.1 to 10 cm (Global: 090)
│ │ ├── 49205 Excision or destruction, open, intra-abdominal tumors, cysts or endometriomas, > 10 cm (Global: 090)
│ │ ├── 49215 Excision of presacral or sacrococcygeal tumor (Global: 090)
│ │ ├── 49250 Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) (Global: 090)
│ │ └── ▶▶ 49255 ◀◀ Omentectomy, epiploectomy, resection of omentum (separate procedure) ← YOU ARE HERE (Global: 090)
│ │
│ └── 49320-49329 Laparoscopic Procedures
💰 RVU & Reimbursement Profile
| Component | Value |
|---|---|
| Work RVU (wRVU) | 12.56 (verify against current CMS MPFS for applicable year) |
| Global Period | 090 (90 days) |
| Bilateral Indicator | 0 — The omentum is a single anatomic structure; bilateral billing rules do not apply. Modifiers -50, -RT, or -LT should never be used. |
| Assistant Surgeon | ✅ Payable (Modifiers -80, -81, -82, -AS apply) |
| Co-Surgeon | ❌ Not applicable (Indicator 0) |
| Team Surgery | ❌ Not applicable (Indicator 0) |
| PC/TC Split | ❌ No — procedure code only (Indicator 0) |
| Modifier -51 Exempt | No |
| Anesthesia | General anesthesia is separately billable by the anesthesiologist (e.g., 00790 for intraperitoneal procedures in upper abdomen). |
🏷️ Modifier Reference
| Modifier | Name | When to Apply |
|---|---|---|
| -22 | Increased Procedural Services | Used when the procedure required significantly greater time and effort than typical (e.g., dense adhesions from previous surgeries or massive frozen pelvis requiring extensive dissection). |
| -59 / -XS | Distinct Procedural Service | Used only if the omentectomy was performed for a completely unrelated diagnosis/pathology from the primary procedure, and documentation strongly supports the distinct nature. |
| -51 | Multiple Procedures | When 49255 is performed as the primary procedure alongside another distinct, non-bundled surgical procedure. |
| -52 | Reduced Services | If the omentectomy was planned but only partially completed due to anatomic or clinical constraints. |
| -80 | Assistant Surgeon | Applied when a second surgeon’s assistance is medically necessary to complete the laparotomy and resection safely. |
🩺 Common ICD-10-CM Pairings
Malignant Neoplasms
| ICD-10 Code | Description | HCC? | Clinical Notes |
|---|---|---|---|
| C56.1 | Malignant neoplasm of right ovary | ✅ HCC | Often drives omentectomy for staging or debulking, provided the primary CPT code doesn’t already bundle it. |
| C56.2 | Malignant neoplasm of left ovary | ✅ HCC | As above, left side. |
| C48.1 | Malignant neoplasm of specified parts of peritoneum | ✅ HCC | Specific code for primary malignancies of the omentum. |
| C78.6 | Secondary malignant neoplasm of retroperitoneum and peritoneum | ✅ HCC | Used when metastatic cancer (from colon, stomach, ovary, etc.) has seeded into the omentum. |
Acute / Ischemic Conditions
| ICD-10 Code | Description | HCC? | Clinical Notes |
|---|---|---|---|
| K55.069 | Acute infarction of intestine, part and extent unspecified | ✅ HCC | The ICD-10-CM index points here for acute omental infarction or ischemic omental necrosis. |
| K56.2 | Volvulus | ✅ HCC | The ICD-10-CM index points here for torsion of the omentum causing an acute surgical abdomen. |
Coding Specificity Reminder
When coding for malignant neoplasms involving the omentum, always distinguish between a primary peritoneal/omental cancer (C48.1) and a secondary/metastatic cancer (C78.6). For secondary malignancies, you must also code the primary site (e.g., C16.9 for stomach cancer) if known.
🏥 MS-DRG Considerations (Inpatient)
Inpatient Coding Reminder
CPT 49255 is typically performed in an inpatient setting. When this procedure drives an inpatient admission, it maps to MDC 06 (Diseases and Disorders of the Digestive System) and the Stomach, Esophageal and Duodenal Procedures DRG family (MS-DRGs 326, 327, 328). If the principal diagnosis is malignant, the case will map to MDC 17 and group to the DRGs for Other Procedures for Poorly Differentiated Neoplasm (MS-DRGs 823, 824, 825).
🔧 ICD-10-PCS Equivalents (Inpatient Facility Coding)
Note
Inpatient facility coders use ICD-10-PCS rather than CPT to drive MS-DRG grouping. The selection of the root operation depends entirely on whether the entire omentum was removed (Resection) or only a portion of it (Excision).
| PCS Code | Full Description | Applicable Modality |
|---|---|---|
0DTU0ZZ | Medical and Surgical, Gastrointestinal System, Resection, Omentum, Open Approach | Total omentectomy |
0DBU0ZZ | Medical and Surgical, Gastrointestinal System, Excision, Omentum, Open Approach | Partial omentectomy / wedge resection |
PCS Character Analysis — 0DTU0ZZ
| Position | Character | Value | Definition |
|---|---|---|---|
| 1 | Section | 0 | Medical and Surgical |
| 2 | Body System | D | Gastrointestinal System |
| 3 | Root Operation | T | Resection (Cutting out or off, without replacement, all of a body part) |
| 4 | Body Part | U | Omentum |
| 5 | Approach | 0 | Open (Cutting through the skin or mucous membrane to expose the site) |
| 6 | Device | Z | No Device |
| 7 | Qualifier | Z | No Qualifier |
PCS Root Operation: Resection vs. Excision
- Use Resection (T) when the operative note explicitly documents the removal of the entire omentum (total omentectomy).
- Use Excision (B) when the surgeon removes only a piece, mass, or wedge of the omentum (partial omentectomy), leaving a portion intact.
📝 Coding Examples
Example 1 — Inpatient Hospital: Primary Omentectomy for Ischemia
Clinical Scenario: A 42-year-old male presents to the ER with acute, severe right-sided abdominal pain. CT imaging reveals a large, twisted fatty mass suggestive of omental torsion and secondary infarction. The general surgeon takes the patient to the OR, performs an exploratory midline laparotomy, and discovers a large segment of infarcted, gangrenous greater omentum. The surgeon completely resects the necrotic omentum. No other procedures are performed.
| Field | Code | Rationale |
|---|---|---|
| CPT | 49255 | Primary and sole open procedure performed; “separate procedure” rule is satisfied. |
| PDx | K56.2 | Volvulus (captures torsion of the omentum as indexed in ICD-10). |
| SDx | K55.069 | Acute infarction of intestine/omentum (captures the resulting gangrene). |
Note
Because 49255 is the only procedure performed in this scenario, the “separate procedure” restriction does not prevent it from being reported.
Example 2 — Inpatient Hospital: Attempted Unbundling
Clinical Scenario: A 55-year-old female with a large benign ovarian fibroma undergoes an open total abdominal hysterectomy (TAH) with bilateral salpingo-oophorectomy. During the surgery, the surgeon notices that the omentum is densely adhered to the fibroma and is causing chronic pain. The surgeon elects to perform an omentectomy alongside the TAH. The office biller attempts to report both 58150 and 49255.
| Field | Code | Rationale |
|---|---|---|
| CPT 1 | 58150 | Primary open TAH with bilateral salpingo-oophorectomy. |
| CPT 2 | DO NOT BILL. | |
| PDx | D27.9 | Benign neoplasm of unspecified ovary. |
Warning
The omentectomy (49255) is bundled into the major abdominal procedure (58150). Because both procedures were performed for the same continuous disease process within the same anatomic field, it is inappropriate to apply modifier -59 to bypass the edit. 49255 must be dropped from the claim.
⚠️ Common Coding Pitfalls
- Failing to adhere to the “Separate Procedure” guidelines: This is the most frequent audit trap for 49255. If you bill an omentectomy alongside another major intra-abdominal surgery without strict, distinct pathology justification, it will trigger an NCCI denial or a post-payment recoupment.
- Billing 49255 for Laparoscopic Procedures: CPT 49255 is an open code. If the operative note details the insertion of trocars and the use of a laparoscope to remove the omentum, you cannot use 49255. You must bill the unlisted code 49329 (Unlisted laparoscopy procedure, abdomen, peritoneum and omentum).
- Billing 49255 with Gynecologic Oncology Codes: Codes like
58950,58951,58952,58953, and58954already include an omentectomy in their CPT descriptor. Billing 49255 alongside them is unbundling. - Applying Bilateral Modifiers: The omentum is not a paired organ. Submitting 49255 with -50, -RT, or -LT will result in immediate claim rejections.
📎 Sources
AMA CPT 2025 Professional Edition · CMS 2025 Medicare Physician Fee Schedule Final Rule (CMS-1807-F) · CMS RVU25A Relative Value Files · NCCI Policy Manual Chapter 6, CMS 2024-2025 · ICD-10-CM Official Guidelines for Coding and Reporting FY2026 · ICD-10-PCS Official Guidelines for Coding and Reporting FY2026 · AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS (2024 Issue 1: Transfer of Omentum)