Coding Decoded

Welcome to the first “Coding Decoded” column of 2025.  There are 420 updates to CPT-4 including 270 new codes and 112 deletions. It doesn’t take an epidemiologist to see that the population of codes is expanding. There should be plenty of material for discussion in the coming months.

One of the most significant changes is the coding for the OPEN removal of abdominal tumors. In the past, codes 49203-49205 were used for under 5 cm, between 5-10 cm and more than 10 cm tumors. As we all know, there’s a huge difference between the 10.1 cm endometrioma and the 25 cm endometrioma. The newer codes reflect this. We now have 49186-49190 that expand the sizes of tumor treated. 49186 and 49187 correlate directly with 49203 and 49204 in tumor size but not times or wRVU. 49188 covers 10.1 cm to 20 cm; 49189 covers 20.1 cm to 30 cm; 49190 covers 30+ cm. The wRVUs directly correlate to these procedures that will also be used by general surgery for open excision of abdominal tumors. The following table details the changes in times and wRVUs.

The laparoscopic code is unchanged, you would still use 58662 (12.15 wRVU, 80 minutes).  As you can see, 58662 pays more wRVU/min than any of the open codes, mostly due to the shorter opening and closing times which are still intraoperative time but considered less intense (so the open codes will have more time that is less intense than the corresponding laparoscopic codes). For those who think we need to revalue, the value for almost every code for every specialty is going down when it is revalued—mainly due to the stringent requirements to be budget neutral and to have a very good reason for the value to go up. Although time isn’t the only factor when valuing a code, it is heavily weighted, and these codes are all at the higher end when compared to the entire CPT code set.