How To Use CPT Code 49203

CPT 49203 describes the excision or destruction of open intra-abdominal tumors, cysts, or endometriomas. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 49203?

CPT 49203 is used to describe the excision or destruction of open intra-abdominal tumors, cysts, or endometriomas. This code is specifically used when the provider removes or destroys one or more abnormal growths within or behind the membrane lining of the abdominal cavity. The size of the largest tumor should be 5 cm in diameter or less.

2. Official Description

The official description of CPT code 49203 is: ‘Excision or destruction, open, intra-abdominal tumors, cysts or endometriomas, 1 or more peritoneal, mesenteric, or retroperitoneal primary or secondary tumors; largest tumor 5 cm diameter or less.’

3. Procedure

1. The provider begins by making an incision in the abdomen, usually in the midline or to one side of the upper or lower abdomen.
2. After the incision, the provider examines the organs and structures in the abdominal cavity for any signs of disease or trauma.
3. Once the abnormal growths are identified, the provider proceeds to excise or destroy them using various techniques depending on their location.
4. After the excision or destruction, the provider irrigates the area, checks for bleeding, removes any instruments, and closes the incision.

4. Qualifying circumstances

CPT 49203 is used for patients who require the excision or destruction of open intra-abdominal tumors, cysts, or endometriomas. These growths can be primary or secondary tumors located in the peritoneal, mesenteric, or retroperitoneal areas. The largest tumor being treated should be 5 cm in diameter or less.

5. When to use CPT code 49203

CPT code 49203 should be used when the provider is performing the excision or destruction of open intra-abdominal tumors, cysts, or endometriomas. It is important to ensure that the size of the largest tumor being treated is 5 cm in diameter or less. If the tumor is larger, different codes should be used.

6. Documentation requirements

To support a claim for CPT 49203, the provider must document the following information:

• Patient’s diagnosis and the need for the excision or destruction procedure
• Size and location of the tumors, cysts, or endometriomas
• Details of the procedure, including the incision site and any specific techniques used
• Any complications or unexpected findings during the procedure
• Post-procedure care instructions and follow-up plans
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 49203, ensure that the procedure meets the criteria outlined in the official description. It is important to accurately report the size and location of the tumors, cysts, or endometriomas. If the largest tumor being treated is larger than 5 cm in diameter, different codes should be used. It is also important to follow any additional guidelines provided by payers or coding guidelines.

8. Historical information

CPT 49203 was added to the Current Procedural Terminology system on January 1, 2008. There have been no updates or changes to the code since its addition. In 2017, it was added to the Inpatient Only (IPO) list for Medicare.

9. Examples

1. A provider performs the excision of a 4 cm ovarian cyst in a patient with endometriosis.
2. A surgeon removes a 3 cm retroperitoneal tumor in a patient with metastatic cancer.
3. An oncologist destroys a 2 cm peritoneal tumor in a patient with primary ovarian cancer.
4. A gynecologist excises multiple 1 cm endometriomas in a patient with chronic pelvic pain.
5. A general surgeon removes a 5 cm mesenteric tumor in a patient with gastrointestinal stromal tumor.
6. A provider performs the excision of a 4 cm ovarian cyst in a patient with endometriosis.
7. A surgeon removes a 3 cm retroperitoneal tumor in a patient with metastatic cancer.
8. An oncologist destroys a 2 cm peritoneal tumor in a patient with primary ovarian cancer.
9. A gynecologist excises multiple 1 cm endometriomas in a patient with chronic pelvic pain.
10. A general surgeon removes a 5 cm mesenteric tumor in a patient with gastrointestinal stromal tumor.