Coding for the Excision/Destruction of Intraabdominal Tumors

“Spotlight on CPT” will be reviewing coding for the excision or destruction of intraabdominal tumors this month. The coding for intraabdominal tumor(s) excision or destruction changed dramatically for 2025. Three codes that previously described these procedures were deleted. Those deleted codes are as follows:

49203     Excision or destruction, open, intra-abdominal tumors, cysts, 

               or endometriomas, 1 or more peritoneal, mesenteric, or 

               retroperitoneal primary or secondary tumors; largest tumor 5 

               cm diameter or less

49204     largest tumor 5.1-10.0 cm diameter

49205     largest tumor greater than 10.0 cm diameter

 

Those codes were replaced with the following new codes:

49186     Excision or destruction, open, intra-abdominal (ie, peritoneal, mesenteric, retroperitoneal), 

               primary or secondary tumor(s) or cyst(s), sum of the maximum length of tumor(s) or cyst(s); 5 

               cm or less

49187     5.1 to 10 cm

49188     10.1 to 20 cm

49189     20.1 to 30 cm

49190     greater than 30 cm

 

Notice the difference in the code descriptions. Previously, codes were assigned based on the largest tumor size determined by its diameter. Using the new codes, the code assignment is based on the maximum length of the tumor(s) or cyst(s) which are all added together.

Several notes apply to these new codes and are as follows:

The size should be measured:

By size of tumor(s) or cyst(s) themselves

No margins

Not tissue in which the tumor or cyst is implanted

Adding maximum length of each tumor or cyst excised or destroyed 

Before excision or destruction performed

When only a partial excision or destruction is performed, the length is determined only by the portion of the tumor or cyst excised or destroyed.

It is appropriate to assign codes 49186-49190 when:

The tumor(s) or cyst(s) are NOT part of a resected organ or soft tissue

Recurrent ovarian, endometrial, tubal, or primary peritoneal gynecological malignancies without lymphadenectomy are done via an open resection

Open resection of all other initial or recurrent ovarian, endometrial, tubal, or primary peritoneal gynecologic malignancies are reported with codes 58943-58960.

Now, light has been shed on coding for the excision/destruction of intraabdominal tumors.

About the Author

Dianna Foley, RHIA, CCS, CDIP, CHPS, has 25 years of HIM experience. She earned her bachelor’s degree from the University of Cincinnati and holds RHIA, CHPS, CDIP, and CCS certifications from AHIMA. Dianna’s an AHIMA-approved ICD-10-CM/PCS trainer, an AHIMA-published author, a participant in AHIMA credential item writing and exam development, and served on the AHIMA Nominating Committee. Dianna has held various HIM positions and is now an independent coding consultant. She previously served as a program director for Medical Coding and HIT. She presents on coding topics at the national, state, and regional levels and serves as OHIMA’s Education Coordinator.

 

Intentional Retainment of Foreign Body

This month, “In the kNOW” is going to explore the appropriate ICD-10-CM code assignment when a foreign body is intentionally left in the body. Now, you may be wondering why a provider would ever leave a foreign body intentionally in a patient’s body. Consider this. If, during an open reduction internal fixation fracture procedure, a drill bit breaks off in a patient’s bone, the provider must weigh the risks to the patient of trying to remove the foreign body as opposed to leaving it in situ. In some circumstances, the foreign body might easily be removed and not pose significant risk to the patient. However, in other cases, perhaps influenced in part by the patient’s age, time under anesthesia, or other factors, the provider may deem it in the best interest of the patient to leave that foreign body where it is. Now comes the challenging part for a coding professional, how do we code that? 

Our first instinct is probably to assign a complication code such as T81.590A-Other complications of foreign body accidentally left in body following surgical operation, initial encounter. However, a review of the 2nd Qtr. 2025 Coding Clinic, would tell us that is incorrect. Instead, we should assign Y65.4 -Failure to introduce or to remove other tube or instrument.

That same Coding Clinic explains this advice is consistent with the National Quality Forum listing of Serious Reportable Events. Appendix A of that list addresses unintended foreign body retention but excludes from reporting objects like broken drill bits or screws, that are intentionally left in when the risk of removal is greater than the risk of retention. 

Now you are In the kNOW!!

About the Author

Dianna Foley, RHIA, CCS, CDIP, CHPS, has 25 years of HIM experience. She earned her bachelor’s degree from the University of Cincinnati and holds RHIA, CHPS, CDIP, and CCS certifications from AHIMA. Dianna’s an AHIMA-approved ICD-10-CM/PCS trainer, an AHIMA-published author, a participant in AHIMA credential item writing and exam development, and served on the AHIMA Nominating Committee. Dianna has held various HIM positions and is now an independent coding consultant. She previously served as a program director for Medical Coding and HIT. She presents on coding topics at the national, state, and regional levels and serves as OHIMA’s Education Coordinator.