CPT® Code 49186

Official Description

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

Common Language Description

The procedure described by CPT® Code 49186 involves the open excision or destruction of intra-abdominal tumors or cysts, which can be either primary or secondary in nature. This means that the tumors may originate in the abdominal cavity or may have spread from other parts of the body. The excision can be performed through surgical techniques that either completely remove the tumor or destroy it using methods such as electrocautery or laser ablation. The surgical approach requires making an incision in the abdomen, allowing access to the peritoneum, which is the membrane lining the abdominal cavity. Care is taken to avoid damaging surrounding structures, including the bowel and other internal organs, during the procedure. Once the peritoneal cavity is accessed, the surgeon can explore the abdominal cavity thoroughly, identifying and assessing any masses or abnormalities present. The procedure is meticulous, requiring careful dissection and retraction to ensure that all tumors or cysts are adequately addressed while preserving the integrity of surrounding tissues and blood vessels. The final steps involve irrigating the abdominal cavity, inspecting for any potential injuries, and properly closing the incision to promote healing.

1. Indications

The procedure described by CPT® Code 49186 is indicated for the excision or destruction of intra-abdominal tumors or cysts. The specific indications include:

Primary Tumors Tumors that originate within the abdominal cavity.
Secondary Tumors Tumors that have metastasized to the abdominal cavity from other sites in the body.
Cysts Fluid-filled sacs that may be present in the abdominal cavity.

2. Procedure

The procedure involves several critical steps to ensure the effective excision or destruction of the tumors or cysts:

Step 1: An incision is made in the abdominal wall to access the peritoneum. The incision is carefully created to minimize trauma to surrounding tissues.
Step 2: The peritoneum is grasped, elevated, and incised, allowing access to the peritoneal cavity. Surgeons take care to avoid injury to the bowel and other internal organs during this step.
Step 3: Once the peritoneal cavity is opened, any adhesions are dissected to expose the abdominal viscera. This step is crucial for visualizing and palpating the entire abdominal cavity.
Step 4: A self-retaining retractor is placed to maintain exposure of the surgical field. This allows the surgeon to have a clear view of the masses and abnormalities present.
Step 5: The location, size, and extent of the primary mass are documented, and surrounding tissues are carefully packed to enhance visibility of the mass.
Step 6: The tumor is either meticulously resected or destroyed using electrocautery or laser techniques. This process is repeated for all identified tumors or cysts.
Step 7: For retroperitoneal tumors, similar techniques are employed, with particular attention to avoiding injury to the kidneys, ureters, and renal vessels.
Step 8: After the tumors or cysts have been addressed, the abdominal cavity is irrigated with an antibiotic solution to reduce the risk of infection.
Step 9: A final inspection of the abdominal cavity is performed to check for any injuries before the instruments are removed and the organs are returned to their anatomical positions.
Step 10: The omentum is replaced over the abdominal contents, and drains may be placed as necessary before closing the fascia and other soft tissues.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any complications that may arise following the surgery. Expected recovery includes managing pain, monitoring for signs of infection, and ensuring proper healing of the incision site. Patients may require follow-up visits to assess recovery and to evaluate any further treatment options if necessary. The placement of drains, if utilized, will also require monitoring to ensure proper drainage and to prevent complications.

Short Descr	OPN EXC/DSTR NTRA-ABD 5 CM/<
Medium Descr	OPEN EXC/DSTRJ INTRA-ABDL TUMOR/CST 5 CM OR LESS
Long Descr	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
Status Code	Active Code
Global Days	090 - Major Surgery
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	2 - Payment restriction for assistants at surgery does not apply to this procedure...
Co-Surgeons (62)	1 - Co-surgeons could be paid, though supporting documentation is required...
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Inpatient Procedures, not paid under OPPS
Type of Service (TOS)	2 - Surgery
Berenson-Eggers TOS (BETOS)	none
MUE	Not applicable/unspecified.