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Adrenal glands are the organs located above the kidneys, which produce hormones and help regulate certain bodily functions. When these glands develop abnormalities or function incorrectly, a urologist may decide to remove them. This surgery is known as an adrenalectomy. As a urology coder, you should be familiar with this procedure so you can correctly code the service.

Continue reading to learn what factors into your adrenalectomy code selection.

Get to Know Adrenalectomy Procedures

Let’s talk about adrenalectomy procedures and explore what we know about how to code them. As a urology coder, you have learned that adrenal glands are triangular organs that sit atop each kidney and are part of the endocrine system. An adrenalectomy is the surgical removal of one or both adrenal glands.

Physicians perform the procedure when the adrenal gland develops masses or nodules that could be malignant or benign, the glands produce excess hormones, or the glands cause other conditions, such as Cushing syndrome, to develop.

Providers can complete an adrenalectomy via open or laparoscopic procedure. Adrenalectomy code descriptors specify the physician can perform a complete or partial removal, and the procedure could include exploration or biopsy. Lastly, the physician can choose to use a transabdominal, lumbar, or dorsal approach for adrenal gland removal.

Depending on the reason for removal, laparoscopic transabdominal adrenalectomy is the most commonly used approach for adrenal gland removal.

Examine This Scenario

It’s Monday morning, you power up your computer to get your workday started, and you find your urology group has finished dictating and signing their surgery notes. As you begin to sort through what is ready to code, you notice a patient with a preoperative diagnosis of right adrenal gland mass and persistently high blood pressure despite medication controls. You take a quick peek at that pathology and notice it is finalized, and you are excited to get your first adrenal gland procedure coded.

The operative note details are as follows:

The physician confirmed the patient’s surgical site in the pre-op area, then the patient was transported to the operating room (OR), prepped, draped, and general anesthesia induced. The patient was positioned in a left lateral decubitus position in preparation for laparoscopic trocar placement. Four incisions were created, trocars were placed, and the abdomen was insufflated. Careful dissection took place around the liver and the vascular anatomy surrounding the liver, adrenal gland, kidney, and vena cava, with good blood control maintained throughout the service. Right adrenal gland was mobilized within gerota fascia, and continued meticulous dissection commenced to separate the gland from the kidney. After the adrenal gland was freed, it was placed in an endocatch bag for removal, later labeled and sent to pathology to diagnose the mass. Hemostasis was ensured, abdomen was desufflated, trocars removed, and skin incisions closed with sutures. The patient was taken to the post-op recovery room for monitoring. Estimated blood loss was 150 ml. Final pathology confirmed pheochromocytoma.

The provider’s documentation supports assigning a laparoscopic adrenalectomy code, so let’s browse the CPT^® code set for a code describing this service. Searching for Endocrine System in the index does not yield great results, so you’ll search for Adrenal Gland and find several procedural code options. These options include codes more aligned with the procedure performed. If you search a little further past Adrenal Gland in the CPT^® Index, you’ll find Adrenalectomy, which includes code choices for the surgical removal of the adrenal gland. After consulting the CPT^® Index, you are ready to verify the code in the code set.

Look at the codes under the Parathyroid, Thymus, Adrenal Glands, Pancreas and Carotid Body header. Then, under the Excision subsection, you’ll find the following two CPT^® codes for adrenalectomies:

• 60540 (Adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsal (separate procedure))
• 60545 (… with excision of adjacent retroperitoneal tumor)

Under the next subsection, Laparoscopy, there is only one code available to choose for an adrenalectomy:

• 60650 (Laparoscopy; surgical, with adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsal)

Based on the provider’s documentation in the scenario, 60650 is the most accurate code to report for this service.

Modifier: Considering the adrenal glands are paired organs, you will want to append bilateral or anatomical modifiers — such as 50 (Bilateral procedure), LT (Left side), or RT (Right side) — to the procedure code. Since the urologist performed the procedure on the right side, appending modifier RT to 60650 offers the greatest amount of specificity about the service provided to this patient.

Remember These Helpful Tips

Overall, when looking at adrenalectomy CPT^® codes, the approach, open or laparoscopic, will be the overarching criteria for selecting an accurate code. Items to note about open adrenalectomy codes include:

• Review all CPT^® coding notes following 60540 and 60545. Be aware that both open adrenalectomy codes (60540, 60545) are deemed as “separate procedure” codes and you might not be allowed to report them with other CPT^® codes.
• Check the National Correct Coding Initiative (NCCI) for bundling edits against other codes, and to see if you need to append a modifier to the adrenalectomy code.
• Lastly, closely examine documentation details captured by the surgeon, as 60545 includes an excision of adjacent retroperitoneal tumor.

Kelly George, CPC, CUC, Contributing Writer