Summary & Overview
CPT 49189: Open Excision/Destruction of Abdominal Tumors or Cysts
CPT code 49189 describes an open surgical procedure to excise or destroy one or more tumors or cysts in the abdomen where the combined maximum length of lesions is 20.1 to 30 cm. This code matters nationally because it captures higher-complexity abdominal tumor resections that influence surgical resource use, inpatient utilization, and reimbursement policy for complex general surgery cases. Payers typically adjudicate claims for such procedures across both commercial and public programs, with major payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
This publication provides a concise reference for clinicians, coding professionals, and policy analysts. Readers will find: an explanation of the clinical service represented by the code; typical sites of service; common modifiers and coding context where available; and the types of benchmarks and billing considerations that are relevant for national payers. When data elements were not provided in the source input, the document notes that those items are not available. The focus is on clear clinical and billing identification rather than payer-specific reimbursement guidance.
Billing Code Overview
CPT code 49189 describes an open surgical excision or destruction of one or more abdominal tumors or cysts. The procedure is defined by the combined maximum length of the removed lesions, totaling 20.1 to 30 cm.
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Service type: Open abdominal tumor or cyst excision/destruction
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Typical site of service: Inpatient or outpatient hospital operating room or surgical suite, depending on clinical complexity and patient condition
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 58-year-old female presents with progressive abdominal distension and intermittent left lower quadrant discomfort. Imaging (CT abdomen/pelvis) demonstrates multiple intra-abdominal cystic masses whose summed maximum diameters measure 24 cm. Preoperative evaluation includes history and physical, lab studies (CBC, CMP), anesthesia assessment, and informed consent for open abdominal tumor/cyst excision. The patient is brought to a hospital operating room for an open laparotomy under general anesthesia. The surgical team performs exploration of the abdominal cavity, identifies the cystic masses adherent to omentum and bowel serosa, and excises the lesions with careful hemostasis. Estimated blood loss is recorded, specimens are sent for pathology, and the abdomen is irrigated and closed. Postoperative workflow includes recovery in PACU, inpatient monitoring for pain control and return of bowel function, pathology review, and discharge planning with follow-up for wound check and oncologic or gynecologic specialist management as indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default/No modifier | Use when no modifier is applicable and standard billing applies |
22 | Increased procedural services |