CPT® Code 49187

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); 5.1 to 10 cm

Common Language Description

The procedure described by CPT® Code 49187 involves the open excision or destruction of intra-abdominal tumors or cysts, which can be either primary or secondary in nature. This surgical intervention is performed through an incision in the abdomen, allowing access to the peritoneal cavity. The tumors or cysts may be completely excised, meaning they are surgically removed in their entirety, or they may be destroyed using techniques such as electrocautery or laser ablation. The procedure begins with careful incision and elevation of the peritoneum, ensuring that surrounding organs, such as the bowel, are not injured during the process. Once the peritoneal cavity is accessed, any adhesions are dissected to expose the abdominal viscera fully. A thorough exploration of the abdominal cavity is conducted, both visually and through palpation, to identify all masses and abnormalities present. A self-retaining retractor is utilized to maintain visibility and access to the surgical site. The size, location, and extent of the primary mass are documented, and surrounding tissues are carefully manipulated to provide a clear view of the tumor. The excision or destruction of the tumor is performed with precision to avoid damaging blood vessels that supply adjacent organs. This meticulous approach is repeated for all identified tumors until they are either excised or destroyed. In cases involving retroperitoneal tumors, similar techniques are employed, with particular attention paid to protecting the kidneys, ureters, and renal vessels. After the procedure, the abdominal cavity is irrigated with an antibiotic solution, and a final inspection is conducted to check for any injuries before the surgical instruments are removed and the organs are returned to their anatomical positions. The omentum is then replaced over the abdominal contents, and drains may be placed as necessary before closing the fascia and other soft tissues.

1. Indications

The procedure described by CPT® Code 49187 is indicated for the excision or destruction of intra-abdominal tumors or cysts. The specific indications include:

Primary Tumors - These are tumors that originate in the abdominal organs.
Secondary Tumors - These tumors have metastasized to the abdominal area from other sites in the body.
Cysts - Fluid-filled sacs that may develop in the abdominal cavity.

2. Procedure

The procedure for CPT® Code 49187 involves several critical steps to ensure the effective excision or destruction of the tumors or cysts. The steps are as follows:

Step 1: Incision - An incision is made in the abdomen to access the peritoneum. Care is taken to avoid injury to surrounding organs, particularly the bowel.
Step 2: Accessing the Peritoneal Cavity - The peritoneum is grasped, elevated, and incised, allowing access to the peritoneal cavity. This step is crucial for visualizing and palpating the abdominal viscera.
Step 3: Dissection of Adhesions - Any adhesions present are dissected to fully expose the abdominal organs, facilitating a thorough examination of the cavity.
Step 4: Exploration - The entire abdominal cavity is explored visually and by palpation to identify all masses and abnormalities. This comprehensive assessment is essential for planning the excision or destruction of tumors.
Step 5: Tumor Identification - A self-retaining retractor is placed to maintain exposure, and the size, location, and extent of the primary mass are documented. Surrounding tissues are carefully packed to enhance visibility of the mass.
Step 6: Tumor Excision or Destruction - The tumor is either meticulously resected or destroyed using electrocautery or laser techniques. This process is repeated for all identified tumors until complete excision or destruction is achieved.
Step 7: Irrigation and Inspection - After the tumors have been addressed, the abdominal cavity is irrigated with an antibiotic solution, and a final inspection is performed to check for any injuries before removing instruments.
Step 8: Closure - The organs are returned to their proper anatomical positions, the omentum is replaced over the abdominal contents, and drains may be placed as needed before closing the fascia and other soft tissues.

3. Post-Procedure

Post-procedure care following the excision or destruction of intra-abdominal tumors or cysts involves monitoring for any complications and ensuring proper recovery. Patients may require observation for signs of infection, bleeding, or other postoperative complications. Pain management is typically addressed, and the surgical site is monitored for healing. Depending on the extent of the procedure and the patient's overall health, follow-up appointments may be scheduled to assess recovery and any further treatment needs. Additionally, the placement of drains may necessitate specific care instructions to prevent infection and ensure proper drainage.

Short Descr	OPN EXC/DSTR NTRA-ABD 5.1-10
Medium Descr	OPEN EXC/DSTRJ INTRA-ABDL TUMOR/CST 5.1-10 CM
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); 5.1 to 10 cm
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.