Urology Coding Alert

Question: The urologist performed a left adrenalectomy and partial upper pole nephrectomy for a patient who had adrenal cancer invading the upper pole of the left kidney. I know that adrenalectomy is bundled into a radical nephrectomy, but am not sure about a partial nephrectomy. Can I submit the claim with both 60540 and 50240?

Indiana Subscriber

Answer: You are correct that the work of a radical nephrectomy includes adrenalectomy. The same holds true with a partial nephrectomy. Code 50240 (Nephrectomy, partial) includes 60540 (Adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsal [separate procedure]). You can, however, sometimes include an appropriate modifier such as XS (Separate structure) with CPT^® code 60540. Before using this tactic, verify that you have supporting documentation and report both codes during the same encounter, especially when different pathological processes (different diagnoses) involve the kidney and the adrenal gland.