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CPT 49188: Open Excision/Destruction of Abdominal Tumors or Cysts (10.1–20 cm)

CPT code 49188 represents an open surgical procedure to excise or destroy one or more tumors or cysts in the abdomen where the total summed maximum lesion length ranges from 10.1 to 20 cm. This procedural code is used to document and bill for open abdominal tumor or cyst removal when lesion burden exceeds smaller-size codes and falls within the specified measurement band. Nationally, accurate coding for sizable intra-abdominal lesions affects clinical documentation, facility resource planning, and payer adjudication for operative services.

Key payers commonly involved with this code include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for the procedure, typical sites of service, and common modifiers associated with operative coding for complex surgeries. The publication outlines benchmarks and payer coverage considerations where available, highlights documentation elements that commonly drive coding and payment decisions, and summarizes relevant clinical parameters tied to the code descriptor. Data not available in the input is noted where applicable. This summary is intended for hospital coding professionals, surgical practices, billing teams, and policy analysts seeking a national-level reference on CPT code 49188 and its clinical billing context.

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Billing Code Overview

CPT code 49188 describes an open surgical procedure to excise or destroy one or more abdominal tumors or cysts when the sum of the maximum lengths of the lesions is 10.1 to 20 cm. The code denotes an open approach rather than a minimally invasive or percutaneous technique.

Service type: Open surgical excision or destruction of abdominal tumors or cysts

Typical site of service: Inpatient or outpatient hospital operating room or ambulatory surgery center, depending on patient condition and facility capabilities.

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CPT 49188: Open Excision/Destruction of Abdominal Tumors or Cysts (10.1–20 cm)

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Billing Code Overview

Service type: Open surgical excision or destruction of abdominal tumors or cysts

Typical site of service: Inpatient or outpatient hospital operating room or ambulatory surgery center, depending on patient condition and facility capabilities.

Clinical & Coding Specifications

Clinical Context

A 52-year-old female presents with progressive abdominal distension and intermittent dull right lower quadrant pain. Cross-sectional imaging (CT abdomen/pelvis) identifies multiple intra-abdominal cystic and solid lesions with a combined maximum linear length measured at 14 cm. The surgical team schedules an open abdominal procedure to excise the tumors/cysts due to size, location, and concern for malignancy. Preoperative workup includes history and physical, labs (CBC, CMP, coagulation studies), informed consent, anesthesia evaluation, and intraoperative pathology (frozen section) as indicated. Intraoperatively, an open midline laparotomy is performed, lesions are identified and resected en bloc with appropriate margin when possible, hemostasis achieved, and abdominal wall closed. Postoperative care includes pain control, wound monitoring, early ambulation, serial abdominal exams, and pathology review to guide further oncologic management. Typical sites of service include an inpatient hospital operating room or ambulatory surgical center for complex open abdominal tumor excisions. The service type is operative open abdominal tumor/cyst excision corresponding to 49188.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the work, time, or technical difficulty substantially exceeds the usual for `49188`.

23 | Unusual anesthesia | Use when general anesthesia is not planned but administered for unusual circumstances for 49188.

50 | Bilateral procedure | Use if the open excision is performed bilaterally on paired organs when applicable.

51 | Multiple procedures | Use when 49188 is reported with other unrelated procedures during the same operative session.

52 | Reduced services | Use when the procedure is partially reduced or not completed as originally planned.

53 | Discontinued procedure | Use if the procedure is started but terminated due to extenuating circumstances.

59 | Distinct procedural service | Use to indicate a separate and distinct procedure or site when other procedures are billed the same day.

62 | Two surgeons | Use when two surgeons work together as primary surgeons performing distinct portions of 49188.

76 is not in the provided list and thus not included. | Data not applicable | Data not applicable

62 already listed above; duplicates avoided. | |

78 | Unplanned return to the operating room | Use when the patient returns for a related procedure during the postoperative period.

80 | Assistant surgeon | Use when a surgical assistant participates in the case for 49188.

81 | Minimum assistant surgeon | Use when a minimum assistant is documented for the procedure.

82 | Assistant (when qualified resident surgeon not available) | Use when an assistant is required and a qualified resident is not available.

AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | Use when an advanced practice provider performs assistant-at-surgery duties.

59 is already included above. | |

Taxonomy Code	Specialty	Notes
`207L00000X`	General Surgery	Most common specialty performing open abdominal tumor/cyst excision.

2080P0004X | Colon and Rectal Surgery | Involved when lesions originate from the colon or mesentery near colorectal structures.

208000000X | Obstetrics & Gynecology | Gynecologic oncologists or general gynecologists perform resections for adnexal/ovarian cysts or tumors.

2086S0122X | Surgical Oncology | Surgical oncologists perform complex resections and oncologic margin management.

207K00000X | Thoracic Surgery | Rarely involved for upper abdominal tumors extending into the diaphragm or chest.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C56.9`	Malignant neoplasm of ovary, unspecified	Ovarian tumors can present as large intra-abdominal masses requiring open excision when size or complexity precludes minimally invasive approaches.

D27.9 | Benign neoplasm of ovary, unspecified | Large benign ovarian cysts or tumors may require open removal when size (sum 10.1–20 cm) or concern for torsion/rupture exists.

K63.5 | Malignant polyp of colon | Masses originating from the colon or mesentery may necessitate open excision if bulky or adherent.

D36.7 | Benign neoplasm of retroperitoneum and peritoneum | Retroperitoneal or peritoneal cysts/neoplasms often require open resection due to size and proximity to vital structures.

C49.9 | Malignant neoplasm of connective and soft tissue, unspecified | Soft tissue sarcomas of the abdominal wall or mesentery are indications for open tumor excision.

N83.2 | Follicular cyst of ovary | Functional or large persistent follicular cysts may be surgically removed when symptomatic and large.

K66.1 | Hemoperitoneum (nontraumatic) | Hemorrhagic cysts or ruptured tumors causing hemoperitoneum can prompt emergent open excision.

R10.9 | Unspecified abdominal pain | Common presenting symptom that leads to imaging and eventual identification of abdominal tumors/cysts addressed by 49188.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`19303`	Mastectomy, simple, complete	Not directly related to abdominal excision; included only when metastatic disease requires mastectomy in the same care episode — otherwise not typically performed with `49188`.

49000 | Exploratory laparotomy, exploratory celiotomy with or without biopsy(s) (separate procedure) | Performed when initial exploration and biopsy are needed prior to definitive excision; may precede 49188 in diagnostic workflows.

49010 | Laparotomy, exploratory, with biopsy(s) of intra-abdominal organ(s) | Used for targeted biopsies if frozen section or diagnostic confirmation is required before or instead of full excision.

49900 | Unlisted laparoscopy procedure, abdomen, peritoneum and omentum | May be reported when a concurrent or prior laparoscopic procedure is performed and no specific CPT exists; complementary in mixed open/laparoscopic cases.

99152 is not in the provided list and therefore not included. | Data not applicable | Data not applicable

Note: Related CPT codes provided in the input were empty; the table above lists commonly associated codes used in clinical workflows with open abdominal tumor/cyst excision.

CPT 49180: Percutaneous Abdominal Needle Biopsy

CPT-49185-PERCUTANEOUS-CHEMICAL-DESTRUCTION-FLUID-COLLECTION

CPT 49185: Percutaneous Chemical Destruction of Fluid Collection

CPT-49186-OPEN-ABDOMINAL-EXCISION-DESTRUCTION-SMALL-TUMORS-CYSTS

CPT 49186: Open Excision/Destruction of Small Abdominal Tumors or Cysts

CPT-49187-OPEN-ABDOMINAL-TUMOR-CYST-EXCISION-5-1-10CM

CPT 49187: Open Abdominal Tumor or Cyst Excision, 5.1–10 cm

CPT-49189-OPEN-ABDOMINAL-TUMOR-CYST-EXCISION-20-1-30CM

CPT 49189: Open Excision/Destruction of Abdominal Tumors or Cysts

CPT-49190-OPEN-ABDOMINAL-TUMOR-CYST-EXCISION-DESTRUCTION-OVER-30CM

CPT 49190: Open Excision/Destruction of Abdominal Tumors or Cysts, >30 cm

CPT-49215-SACROCOCCYGEAL-MASS-EXCISION

CPT 49215: Excision of Sacrococcygeal Mass

CPT-49250-UMBILICAL-EXCISION-HERNIA-INFECTION

CPT 49250: Excision of Umbilicus for Hernia or Nonhealing Infection

CPT-49255-OMENTECTOMY-FOR-METASTATIC-ABDOMINAL-PELVIC-CANCER

CPT 49255: Omentectomy for Metastatic Abdominal or Pelvic Cancer

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the work, time, or technical difficulty substantially exceeds the usual for `49188`.