Coding Ahead
CasePilot
Medical Coding Assistant
Case2Code
Search and Code Lookup Tool
RedactPHI
HIPAA-Compliant PHI Redaction
DetectICD10CM
ICD-10-CM Code Detection
Log in Register free account
1 code page views remaining. Guest accounts are limited to 1 page view. Register free account to get 5 more views.
Log in Register free account
CPT®
49220

CPT® Code 49220
Deleted

Official Description

Staging laparotomy for Hodgkins disease or lymphoma (includes splenectomy, needle or open biopsies of both liver lobes, possibly also removal of abdominal nodes, abdominal node and/or bone marrow biopsies, ovarian repositioning)

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The CPT® Code 49220 refers to a surgical procedure known as staging laparotomy, specifically performed for patients diagnosed with Hodgkin's disease or lymphoma. This procedure is integral in the staging process, which helps determine the extent of the disease within the body. The staging laparotomy includes several critical components: a splenectomy, which is the surgical removal of the spleen; needle or open biopsies of both liver lobes; and potentially the removal of abdominal lymph nodes. Additionally, the procedure may involve obtaining biopsies from the bone marrow and repositioning the ovaries in women of child-bearing age to protect them from radiation exposure during subsequent treatments. The primary goal of this procedure is to accurately assess the spread of Hodgkin's disease, allowing for appropriate treatment planning. Although the use of staging laparotomy has decreased with advancements in imaging techniques, it remains a vital option in certain clinical scenarios. The procedure is performed through a midline abdominal incision, providing access to the spleen, liver, and lymphatic structures, which are essential for comprehensive evaluation and staging of the disease. This thorough approach ensures that all necessary tissue samples are collected for accurate diagnosis and treatment planning.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The staging laparotomy (CPT® Code 49220) is indicated for patients diagnosed with Hodgkin's disease or lymphoma. The procedure is performed to evaluate the extent of the disease and to differentiate between patients with localized disease confined to above the diaphragm and those with more extensive involvement. This surgical intervention is particularly relevant in cases where imaging techniques may not provide sufficient information for staging or treatment planning.

  • Hodgkin's Disease The procedure is indicated for patients diagnosed with Hodgkin's disease to assess the disease's extent.
  • Lymphoma It is also indicated for patients with lymphoma, allowing for comprehensive evaluation and staging.
  • Assessment of Disease Extent The procedure helps distinguish between localized disease and more extensive disease, guiding treatment decisions.

2. Procedure

The staging laparotomy involves several critical procedural steps that are essential for accurate staging and evaluation of Hodgkin's disease or lymphoma.

  • Step 1: Incision A midline incision is made in the abdomen to provide access to the necessary internal structures. This incision allows the surgeon to visualize and manipulate the spleen, liver, and abdominal lymph nodes effectively.
  • Step 2: Splenectomy The spleen is exposed and mobilized, then displaced medially to access the splenorenal, splenocolic, and gastrosplenic ligaments. These ligaments are ligated and divided to facilitate the removal of the spleen. The splenic artery and vein are then visualized, ligated, and divided, allowing for the complete removal of the spleen.
  • Step 3: Inspection and Control of Bleeding After the spleen is removed, the surgical site is inspected for any bleeding, particularly focusing on the splenic pedicle and retroperitoneal space. Any bleeding encountered is controlled using electrocautery or suture ligation of blood vessels to ensure hemostasis.
  • Step 4: Liver Biopsy The liver is then exposed, and tissue samples are obtained from both lobes. This step is crucial for assessing any involvement of the liver in the disease process.
  • Step 5: Lymph Node Biopsy Abdominal lymph nodes are exposed and inspected. Tissue samples are collected from multiple nodes, and any enlarged nodes are excised to provide further diagnostic information.
  • Step 6: Ovarian Repositioning If radiation therapy is planned for the treatment of Hodgkin's disease, the ovaries may be surgically repositioned outside of the radiation field in women of child-bearing age to protect them from potential radiation damage.
  • Step 7: Bone Marrow Biopsy Bone marrow biopsies may also be obtained during this procedure, with common biopsy sites being the sternum or iliac crest, to evaluate for any bone marrow involvement.
  • Step 8: Closure Following the completion of all staging procedures, the abdominal wound is irrigated to reduce the risk of infection, and the abdomen is then closed securely.

3. Post-Procedure

After the staging laparotomy is completed, patients typically require monitoring for any complications related to the surgery, such as bleeding or infection. The expected recovery period may vary depending on the individual patient's health and the extent of the procedure performed. Patients may experience pain at the incision site, which can be managed with appropriate analgesics. Follow-up care is essential to assess the results of the biopsies and to plan further treatment based on the staging results. Additionally, patients may need to be counseled regarding fertility preservation options if ovarian repositioning was performed.
Short Descr MULTIPLE SURGERY ABDOMEN
Medium Descr STAGING LAPAROTOMY HODGKINS DISEASE/LYMPHOMA
Long Descr Staging laparotomy for Hodgkins disease or lymphoma (includes splenectomy, needle or open biopsies of both liver lobes, possibly also removal of abdominal nodes, abdominal node and/or bone marrow biopsies, ovarian repositioning)
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) P1G - Major procedure - Other
MUE Not applicable/unspecified.
CCS Clinical Classification 89 - Exploratory laparotomy
Date
Action
Notes
2020-12-31 Deleted Code deleted.
2011-01-01 Changed Medium description changed. Short description changed.
2002-01-01 Changed Code description changed.
Pre-1990 Added Code added.
Code
Description
Code
Description
Code
Description
Code
Description
CasePilot

Get instant expert-level medical coding assistance.

Ask about:
CPT Codes Guidelines Modifiers Crosswalks NCCI Edits Compliance Medicare Coverage
Example: "What is CPT code 99213?" or "Guidelines for E/M services"