Learn the New ObGyn Codes, Deletions, and Guideline Updates by Jan. 1
Get the latest OBGYN CPT 2025 updates, including new codes, deletions, and revised guidelines. Ensure accurate billing and stay compliant with the latest changes.
OB/GYN Medical Billing & Coding Alert
With the arrival of January 1, your OB/GYN practice will face several challenges related to the 2025 CPT® updates. These include new codes for tumor and cyst excisions, as well as revisions and additions to existing guidelines — some of which may leave you questioning their reasoning.
Stay ahead of these changes to ensure your claims avoid complications and delays in the coming year.
Explore the New Coding Options in 2025 for Tumor and Cyst Excision
Starting in CPT® 2025, codes 49203-49205 are deleted, which previously depended on the size of the largest tumor or cyst. Instead, you will now use codes based on the total sum of the maximum length of all tumors or cysts removed, as defined below:
- 49186: Excision or destruction, open, intra-abdominal (peritoneal, mesenteric, retroperitoneal), primary or secondary tumor(s) or cyst(s), total maximum length 5 cm or less
- 49187: Excision or destruction, open, intra-abdominal (peritoneal, mesenteric, retroperitoneal), primary or secondary tumor(s) or cyst(s), total maximum length 5.1 to 10 cm
- 49188: Excision or destruction, open, intra-abdominal (peritoneal, mesenteric, retroperitoneal), primary or secondary tumor(s) or cyst(s), total maximum length 10.1 to 20 cm
- 49189: Excision or destruction, open, intra-abdominal (peritoneal, mesenteric, retroperitoneal), primary or secondary tumor(s) or cyst(s), total maximum length 20.1 to 30 cm
- 49190: Excision or destruction, open, intra-abdominal (peritoneal, mesenteric, retroperitoneal), primary or secondary tumor(s) or cyst(s), total maximum length greater than 30 cm
Important Notes:
- Do not report codes 49186-49190 in conjunction with codes 49000, 49010, 49215, 58943, 58950, 58951, 58952, 58953, 58954, 58956, 58958, or 58960.
- For excision of a perinephric cyst, use code 50290.
- The deleted codes (49203, 49204, 49205) are now replaced by 49186-49190 for open excision or destruction of intra-abdominal tumors or cysts.
- For excision or destruction of endometriomas via open method, use code 58999.
“These new coding options allow for more precise reporting of intra-abdominal tumor or cyst excisions, based on the combined maximum length of the tumors or cysts removed,” according to the CPT® guidelines.
Important Code Deletions to Note for 2025
Starting January 1, CPT® 2025 deletes code 58957 (Resection (tumor debulking) of recurrent ovarian, tubal, primary peritoneal, uterine malignancy, with omentectomy, if performed).
For resection (tumor debulking) of recurrent ovarian, endometrial, tubal, or primary peritoneal gynecological malignancies, with omentectomy (if performed) but without lymphadenectomy, you should now use codes 49186-49190, as indicated in the parenthetical note before 58958 (Resection of recurrent ovarian, tubal, primary peritoneal, uterine malignancy with omentectomy and pelvic lymphadenectomy/limited para-aortic lymphadenectomy). Reporting 58957 after January 1 will result in a claim denial.
Additionally, two influenza vaccine codes are now deleted:
- 90654 (Influenza virus vaccine, trivalent (IIV3), split virus, preservative-free, for intradermal use)
- 90630 (Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative-free, for intradermal use)
Instead, CPT® 2025 directs you to use the following codes: 90653, 90655-90658, 90660-90662, 90664, 90666-90668, 90672-90674, 90682, 90685-90689, 90694, and 90756.
You said:
New and Revised Guidelines You Need to Follow for CPT® 2025
CPT® 2025 doesn’t just introduce new codes—it also brings changes to existing guidelines. Adhering to these updated guidelines is crucial to avoid claim denials. Here’s a breakdown of the revised instructions:
|
Old Notes |
New Notes |
|
Excision or destruction of endometriomas (open method): Use codes 49203-49205, 58957, 58958 |
Excision or destruction of endometriomas (open method): Use code 58999 |
|
Resection of recurrent ovarian, tubal, primary peritoneal, or uterine malignancy: Use codes 58957, 58958 |
Resection of recurrent ovarian, tubal, primary peritoneal, or uterine malignancy: Use code 58958 |
|
Do not report 58943 in conjunction with 49186, 49187, 49188, 49189, or 49190 |
Do not report 58943 with codes 49186-49190 |
|
Do not report 58950, 58951, 58952 in conjunction with 49186, 49187, 49188, 49189, or 49190 |
Do not report 58950, 58951, 58952 with codes 49186-49190 |
|
Do not report 58953, 58954 in conjunction with 49186, 49187, 49188, 49189, or 49190 |
Do not report 58953, 58954 with codes 49186-49190 |
|
Do not report 58956 in conjunction with 49255, 58150, 58180, 58262, 58263, 58550, 58661, 58700, 58720, 58900, 58925, 58940, 58957, or 58958 |
Do not report 58956 with codes 49186-49190, 49255, 58150, 58180, 58262, 58263, 58550, 58661, 58700, 58720, 58900, 58925, 58940, or 58958 |
|
Do not report 58957, 58958 in conjunction with 38770, 38780, 44005, 49000, 49203-49215, 49255, 58900-58960 |
Do not report 58957, 58958 with codes 38770, 38780, 44005, 49000, 49186-49190, 49215, 49255, 58900-58960 |
|
Do not report 58960 in conjunction with 49186, 49187, 49188, 49189, or 49190 |
Do not report 58960 with codes 49186-49190 or 58958 |
BillingFreedom As An Expert on Navigating CPT® 2025 Code and Guideline Changes
BillingFreedom is the ideal partner for OBGYN practices, offering unmatched expertise in handling the complexities of OBGYN coding and billing. Our team stays up-to-date with the latest CPT® code updates and guideline changes, ensuring that your practice remains compliant and avoids costly claim denials. We specialize in accurately applying new and revised codes for tumor/cyst excisions, endometrioma treatments, and recurrent gynecological malignancies, as well as staying on top of influenza vaccine code changes. By relying on BillingFreedom, your practice benefits from precise billing that aligns with the latest coding standards, saving you time and preventing errors.
Let us handle your OBGYN billing needs with confidence and expertise in the evolving coding landscape.
For more details about our exceptional medical billing services, please don't hesitate to email us at info@billingfreedom.com or call us at +1 (855) 415-3472.
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