2025 CPT code 49204
(Active) Effective Date: N/A Revision Date: N/A Surgery - Excision and Destruction Procedures on the Abdomen, Peritoneum, and Omentum Surgery Feed
Open excision or destruction of one or more intra-abdominal tumors, cysts, or endometriomas (peritoneal, mesenteric, or retroperitoneal, primary or secondary); largest tumor 5.1-10.0 cm.
Modifiers may be applicable depending on the circumstances of the procedure (e.g., 59 for distinct procedural service, 22 for increased procedural service). The information provided here is valid as of today, 03 December 2024, and may change.
Medical necessity is established by clinical findings, diagnostic imaging, and/or biopsy results indicating the presence of a lesion(s) requiring surgical intervention.The size of the lesion(s) must meet the criteria for 49204. The procedure must be deemed medically necessary by the treating physician.
The surgeon is responsible for performing the entire procedure, including pre-operative assessment, incision, exploration, excision or destruction of the lesion(s), hemostasis, irrigation, and closure of the incision. Post-operative care may be reported separately.
In simple words: This code covers a surgery to remove or destroy abnormal growths (tumors, cysts, or similar) inside the abdomen.The largest growth must be between 5.1 and 10 centimeters across. The surgeon opens the abdomen to do this surgery.
This CPT code describes the open surgical procedure for the excision or destruction of one or more intra-abdominal tumors, cysts, or endometriomas located within the peritoneal, mesenteric, or retroperitoneal spaces.The procedure involves an open abdominal incision to access and remove or destroy the growths. The largest tumor in the group must measure between 5.1 and 10.0 centimeters in diameter.The procedure may involve multiple techniques depending on the location and nature of the lesions. The procedure includes examination of the abdominal organs and structures for evidence of disease or trauma, excision or destruction of the lesions, irrigation of the surgical site, hemostasis, and closure of the incision.
Example 1: A 55-year-old female presents with a large ovarian cyst measuring 7cm.The cyst is surgically removed via an open procedure.Code 49204 is appropriate., A 60-year-old male undergoes surgery for removal of multiple peritoneal tumors. The largest tumor is 8cm in size. The surgeon utilizes laparotomy for access and complete removal of all the lesions. 49204 is reported., A 40-year-old female presents with suspected retroperitoneal metastasis from a known primary colon cancer. An open procedure reveals a single 6cm mass; the mass is excised. Code 49204 is appropriate.
Complete operative report detailing the approach, size and number of lesions removed, location of lesions (peritoneal, mesenteric, retroperitoneal), and intraoperative findings.Preoperative imaging (CT, MRI, Ultrasound) and pathology results are necessary to confirm diagnosis and size of the largest tumor.
** This code should only be used when the largest tumor excised falls within the specified size range (5.1-10.0 cm).Always refer to the most current CPT coding guidelines and NCCI edits before submitting claims.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Fee Schedule: Refer to historical CPT fee schedules for relevant data.The information provided here is valid as of today, 03 December 2024, and may change.
- Specialties:General Surgery, Gynecologic Oncology, Surgical Oncology
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center