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Urology Coding Alert

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Nephrectomy With Adrenal, Lymph Removal

Question: A patient had an adrenal tumor and a renal tumor, as well as peritoneal lymphadenopathy. The urologist did an adrenalectomy, a partial nephrectomy, and dissected out some of the lymph nodes in the peritoneum. I am stuck on the lymph nodes. The op report states "The bowel itself looked normal; however there were palpable lymph nodes in the mesentery. Several of these lymph nodes were dissected out and excised." Would the lymph node excision be incidental to the other procedures? Minnesota Subscriber Answer: First, you'll report CPT 50240 (Nephrectomy, partial) for the partial nephrectomy. Then, report CPT 60540 (Adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsal [separate procedure]) for the adrenalectomy. Append modifier 59 (Distinct procedural service) to override the Correct Coding Initiative (CCI) bundle between 50240 and 60540. Reasoning: Because there is also an independent tumor in the adrenal, [...]