Coding Corner: Intra-Abdominal Tumor Excision or Destruction Code Changes | Bridget Toomey, MS, CPC, CPCO, CPB, CPPM
Bridget Toomey, MS, CPC, CPCO, CPB, CPPM
Beginning January 1, 2025, CPT has made changes to the intra-abdominal tumor excision/destruction CPT codes. CPT codes 49203, 49204, and 49205, which were selected based on the size of the largest tumor removed, have been deleted and replaced with five new codes. These replace CPT codes 49203-5, codes based on the excision or destruction of the largest single tumor to reflect that the work of removing many small tumors is greater than just the work of the largest of many. The new codes are based on the sum of the maximum length of each tumor(s) or cyst(s) excised.
- 49186 Excision or destruction, open, intra-abdominal (i.e., 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 (wRVU 22.00)
- 49187 5.1 to 10 cm (wRVU 28.65)
- 49188 10.1 to 20 cm (wRVU 34.00)
- 49189 20.1 to 30 cm (wRVU 40.00)
- 49190 greater than 30 cm (wRVU 50.00)
Things to know:
- Only the tumors or cyst should be used in the measurements- not surrounding tissues or margins.
- Should be measured in situ and documented in operative report.
- Includes cytoreduction, debulking or other methods of removal of tumors (s) or cyst(s). The 2025 CPT code release has 420 updates. 270 of those are new codes, 112 are deletions, and 38 are revisions. All updates took place January 1, 2025.
- Do not report codes 49186-49190 in conjunction with codes 58943, 58950, 58951, 58952, 58953, 58954, 58956, 58958, or 58960.
- Additionally, please note that CPT 58957- was deleted. The parenthetical note before 58958 now refers you to use 49186-49190 for resection [tumor debulking] of recurrent ovarian, endometrial, tubal, or primary peritoneal gynecological malignancies, with omentectomy, if performed, without lymphadenectomy.
Bridget Toomey, MS, CPC, CPCO, CPB, CPPM is the Clinical Department Administrator of the OB-GYN Department at the University of Iowa Health Care in Iowa City, IA.