adrenalectomy

DEFINITION of adrenalectomy

An adrenalectomy is the surgical removal of one (unilateral) or both (bilateral) adrenal glands, either partially or completely. It is most commonly performed to treat adrenal tumors (benign or malignant), hormone-secreting tumors causing Cushing’s syndrome or Conn’s syndrome, pheochromocytoma, or metastatic disease to the adrenal gland. From a medical-coding perspective, adrenalectomy documentation must clarify: Extent (partial vs. complete) Laterality (right, left, bilateral) Approach (open transabdominal, laparoscopic, retroperitoneoscopic, robotic) Indication (tumor type, hormone excess, malignancy, metastasis) Concurrent procedures (nephrectomy, lymphadenectomy)

These distinctions directly affect CPT and ICD-10 code selection. Adrenalectomy is also abbreviated as ADX when referring to the procedure or resulting state. The term derives from Latin ad (near/at) + renalis (relating to the kidneys) + Greek -ektomia (a cutting out).

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ETYMOLOGY of adrenalectomy

latin greek - The word is composed of Latin and Greek roots:

ad-: From Latin ad, meaning “near” or “at” — indicating proximity to the kidneys

ren- / renal: From Latin ren / renes meaning “kidney” — the adrenal glands sit atop the kidneys

-ectomy: From Greek -ektomia, meaning “a cutting out,” derived from ektemnein (“to cut out”), combining ek (“out”) + temnein (“to cut”)

• ad- → Latin ad, meaning “near, at”
• ren- → Latin ren, meaning “kidney”
• -ectomy → Greek ektomē, meaning “cutting out” or “excision”
• adrenalectomy literally means “cutting out [the gland] near the kidney.”

Note: The Greek equivalent is epinephridio (from epi, “upon,” + nephros, “kidney”), reflecting the same anatomical relationship from a Greek perspective.

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Related Terms

Term	Meaning	Coding Relevance
pheochromocytoma	Catecholamine-secreting adrenal medulla tumor	Most common malignant indication; affects code selection
adrenocortical carcinoma	Malignant tumor of the adrenal cortex	Distinct ICD-10 code; may require radical approach
Cushing’s syndrome	Excess cortisol from adrenal hyperplasia or tumor	Common indication; document etiology (ACTH-dependent vs. independent)
Conn’s syndrome	Primary hyperaldosteronism from adrenal adenoma	Indication for [[adrenalectomy
nephrectomy	Surgical removal of kidney	May be performed concurrently; CCI bundling rules apply
lymphadenectomy	Removal of lymph nodes	May be separately coded if documented as distinct service
retroperitoneoscopy	Posterior endoscopic approach to retroperitoneum	Approach distinction affects operative complexity documentation
adrenal cortex	Outer layer of adrenal gland; produces steroids	Cortical vs. medullary origin affects diagnosis coding
adrenal medulla	Inner layer; produces catecholamines (epinephrine)	Source of pheochromocytoma

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Common Medical Terms Using the Root

• Adrenal adenoma - Benign glandular tumor of the adrenal gland; most common adrenal tumor

• Adrenocortical - Pertaining to the adrenal cortex

• Adrenomedullary - Pertaining to the adrenal medulla

• Adrenarche - Onset of adrenal androgen secretion at puberty

• Suprarenal - Latin synonym for adrenal (supra = above + ren = kidney)

• ADX - Abbreviation for adrenalectomy or the adrenalectomized state

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Common Clinical Indications

• pheochromocytoma (most common malignant indication)

• Adrenocortical carcinoma

• Cushing’s syndrome (cortisol-secreting adrenal adenoma)

• Conn’s syndrome / Primary hyperaldosteronism (aldosterone-secreting adenoma)

• Adrenal metastasis from other primary malignancy

• Non-functioning adrenal incidentaloma (large or growing)

• Neuroblastoma (pediatric)

Types of Adrenalectomy

• Unilateral adrenalectomy: Removal of one adrenal gland; most common; patient typically does not require lifelong steroid replacement

• Bilateral adrenalectomy: Removal of both adrenal glands; requires lifelong corticosteroid and mineralocorticoid replacement

• Partial adrenalectomy (cortex-sparing): Removes only the tumor while preserving functional adrenal tissue; preferred in bilateral or hereditary disease (e.g., MEN2, VHL)

Surgical Approaches

• Open transabdominal: Large incision; used for large or malignant tumors; higher morbidity

• Open lumbar or dorsal: Flank or posterior approach; less common

• Laparoscopic adrenalectomy: Minimally invasive; gold standard for tumors < 6 cm

• Retroperitoneoscopic adrenalectomy: Posterior laparoscopic approach; avoids peritoneal cavity

• Robotic-assisted adrenalectomy: Enhanced visualization and dexterity; reported under 60650 with appropriate documentation

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Documentation Clues for Coders

Look for phrases such as:

• “Adrenal gland removed”

• “En bloc resection of adrenal”

• “Adrenal mass excised”

• “Laparoscopic port placement” (confirms approach)

• “Retroperitoneal dissection”

• “Right/left adrenal” (confirms laterality)

• “Bilateral adrenalectomy” (flags need for steroid replacement documentation)

• “Specimen to pathology” (confirms tissue removal, not just exploration/biopsy)

• “Exploration of adrenal gland with biopsy” (may still be coded 60540/60650 per CPT descriptor)

These help determine approach, extent, laterality, and bundling vs. separate procedure rules.

Coder’s Notes

• Approach determines CPT: Open = 60540 or 60545; Laparoscopic = 60650

• 60540 and 60650 are “separate procedure” codes per CPT — do not bill separately when adrenalectomy is bundled into a more comprehensive procedure (e.g., radical nephrectomy 50545)

• CCI bundling: Medicare’s NCCI bundles both 60540 and 60650 with all nephrectomy codes — adrenalectomy is considered inclusive when performed with nephrectomy

• If surgeon performs significant additional work (e.g., excising a retroperitoneal mass), append modifier -22 to represent increased procedural service

• Laterality modifiers: Use modifier -LT (left side) or -RT (right side) when required by payer; some payers reject modifier -50 for bilateral and require the code billed twice with -LT and -RT

• Bilateral adrenalectomy: If both glands removed in same session, check payer rules — use modifier -50 or bill twice with -LT/-RT

• For robotic-assisted approach, report 60650 — there is no separate robotic modifier required by most payers, but documentation must describe the robotic technique

• Postprocedural adrenocortical hypofunction following bilateral adrenalectomy should be coded as E89.6

ICD-10-CM Diagnosis Codes

Code	Description
C74.00	Malignant neoplasm of cortex of adrenal gland, unspecified
C74.01	Malignant neoplasm of cortex of right adrenal gland
C74.02	Malignant neoplasm of cortex of left adrenal gland
C74.10	Malignant neoplasm of medulla of adrenal gland, unspecified
C74.11	Malignant neoplasm of medulla of right adrenal gland
C74.12	Malignant neoplasm of medulla of left adrenal gland
D35.00	Benign neoplasm of adrenal gland, unspecified
D35.01	Benign neoplasm of right adrenal gland
D35.02	Benign neoplasm of left adrenal gland
E26.01	Conn’s syndrome (primary hyperaldosteronism due to adrenal adenoma)
E24.0	Pituitary-dependent Cushing’s disease
E24.02	Cushing’s syndrome due to adrenal adenoma
E27.5	Adrenomedullary hyperfunction (pheochromocytoma-related)
E89.6	Postprocedural adrenocortical (-medullary) hypofunction
D44.10	Neoplasm of uncertain behavior of adrenal gland, unspecified
D44.11	Neoplasm of uncertain behavior of right adrenal gland
D44.12	Neoplasm of uncertain behavior of left adrenal gland

CPT Codes

Code	Description
60540	Adrenalectomy, partial or complete, OR exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsal (separate procedure)
60545	Adrenalectomy, partial or complete, OR exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsal; with excision of adjacent retroperitoneal tumor
60650	Laparoscopy, surgical; adrenalectomy, partial or complete, OR exploration of adrenal gland with or without biopsy

Common Modifiers

Modifier	Use
-LT	Left side — append to specify left adrenal gland
-RT	Right side — append to specify right adrenal gland
-50	Bilateral procedure — bilateral adrenalectomy same session (check payer policy)
-22	Increased procedural services — extra work (e.g., retroperitoneal mass excision)
-51	Multiple procedures — when adrenalectomy is performed alongside another procedure (if not bundled)
-59	Distinct procedural service — use with caution given NCCI bundling with nephrectomy codes

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DERIVATIONS of adrenalectomy

TABLE definition AS Definition
FROM #medterm 
WHERE length(filter(roots, (word) => econtains([[adrenalectomy]].roots, word))) > 0 AND file.name != [[adrenalectomy]].file.name
SORT file.name ASC

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Query functionality

TABLE definition AS Definition
FROM #medterm 
WHERE file.name != this.file.name
AND any(contains(this.definition, definition))

Med roots Appendix A Prefixes Appendix B Combining Forms Appendix C Suffixes Appendix D Suffix forms