Urology Coding Alert

Question:  In CPT®, 60545 is the code to report when you excise a retroperitoneal mass in addition to the adrenalectomy. If the urologist uses a laparoscopic approach, would 60650 cover both the excision and adrenalectomy? 

Michigan Subscriber

Answer: Code 60650 (Laparoscopy, surgical, with adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsal) does not include the removal of an associated retroperitoneal mass like 60545 (Adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsal [separate procedure]; with excision of adjacent retroperitoneal tumor) does. 

Option 1: To indicate the extra work associated with excision of a contiguous retroperitoneal mass, consider adding modifier 22 (Increased procedural service) to code 60650. The urologist needs to clearly document the extra work and time spent on the removal. 

Option 2: You can instead consider adding the unlisted codes 49329 (Unlisted laparoscopy procedure, abdomen, peritoneum and omentum) or 60659 (Unlisted laparoscopy procedure, endocrine system) to your 60650 claim to describe the extra dissection and surgical work performed. Again, the urologist will need to provide detailed documentation.