CPT® Code 49189

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); 20.1 to 30 cm

Common Language Description

Open excision or destruction of intra-abdominal tumors or cysts involves a surgical procedure where an incision is made in the abdomen to access and treat tumors or cysts located within the peritoneal, mesenteric, or retroperitoneal areas. These tumors can be classified as either primary, originating from the abdominal organs, or secondary, which have spread from other parts of the body. The procedure may involve complete excision of the tumor or cyst, or it may utilize techniques such as electrocautery or laser ablation to destroy the tumor tissue. The surgical approach requires careful dissection to avoid damaging surrounding structures, including the bowel and other vital organs. Once the abdominal cavity is opened, the surgeon will explore the area visually and by palpation to identify all masses and abnormalities. The procedure is meticulous, ensuring that blood vessels supplying adjacent organs are preserved during tumor resection. After the tumors or cysts are addressed, the abdominal cavity is thoroughly irrigated, inspected for any potential injuries, and the organs are returned to their anatomical positions before closure. This procedure is indicated for tumors or cysts with a combined maximum length ranging from 20.1 to 30 cm, and specific coding is required based on the size of the tumors or cysts being treated.

1. Indications

The procedure is indicated for the excision or destruction of intra-abdominal tumors or cysts that may be either primary or secondary in nature. The following conditions may warrant this surgical intervention:

Primary Tumors Tumors that originate from the abdominal organs.
Secondary Tumors Tumors that have metastasized to the abdominal cavity from other sites in the body.
Cysts Fluid-filled sacs that may require removal due to size, symptoms, or potential complications.

2. Procedure

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

Step 1: Incision An incision is made in the abdominal wall to access the peritoneal cavity. Care is taken to reach the peritoneum without injuring underlying structures.
Step 2: Opening the Peritoneal Cavity The peritoneum is grasped, elevated, and incised to open the abdominal cavity. This allows for direct access to the internal organs and any present masses.
Step 3: Exploration The abdominal cavity is explored visually and by palpation to identify all tumors, cysts, and other abnormalities. This thorough examination is crucial for determining the extent of the disease.
Step 4: Exposure of Tumors A self-retaining retractor is placed to maintain exposure of the surgical field. The size, location, and extent of the tumors or cysts are documented, and surrounding tissues are carefully packed to enhance visibility.
Step 5: Tumor Resection or Destruction The identified tumors or cysts are either meticulously resected or destroyed using electrocautery or laser techniques. This step is repeated for all identified masses until complete excision or destruction is achieved.
Step 6: Management of Retroperitoneal Tumors If retroperitoneal tumors are present, similar techniques are employed, with particular attention to avoiding injury to the kidneys, ureters, and renal vessels.
Step 7: Irrigation and Inspection The abdominal cavity is irrigated with an antibiotic solution to reduce the risk of infection. A final inspection is conducted to check for any injuries before proceeding to closure.
Step 8: Closure After ensuring all instruments are removed and organs are returned to their proper anatomical positions, the omentum is replaced over the abdominal contents, drains are placed if necessary, and the fascia and other soft tissues are closed.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any signs of complications, such as infection or bleeding. The surgical site will be assessed for proper healing, and any drains placed during the procedure will be managed according to standard protocols. Patients may require pain management and will be advised on activity restrictions during the recovery period. Follow-up appointments will be scheduled to evaluate the surgical outcome and to monitor for any recurrence of tumors or cysts.

Short Descr	OPN EXC/DST NTRA-ABD 20.1-30
Medium Descr	OPEN EXC/DSTRJ INTRA-ABDL TUMOR/CST 20.1-30 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); 20.1 to 30 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.