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.