0GT40ZZ
Resection Adrenal Glands, Bilateral to No Qualifier with No Device, Open Approach
Procedural Specifications
| Clinical Axis | Detail Definition |
|---|---|
| Section | 0 Medical and Surgical |
| Body System | G Endocrine System |
| Operation | T Resection |
| Body Part | 4 Adrenal Glands, Bilateral |
| Approach | 0 Open |
| Device | Z No Device |
| Qualifier | Z No Qualifier |
Operation Definition
Cutting out or off, without replacement, all of a body part
Procedure Overview
Resection in the endocrine system means the complete surgical removal of a gland such as the thyroid, a parathyroid gland, an adrenal gland, or the pituitary, without any replacement structure put in its place. It is one of the most frequently performed procedures in endocrine surgery because so many endocrine conditions, from cancer to hormone-secreting tumors to autoimmune overactivity, are best treated by taking the entire gland out.
Common reasons include thyroid cancer or a large multinodular goiter, Graves' disease that has not responded to medication, a parathyroid adenoma causing hyperparathyroidism, an adrenal tumor such as a pheochromocytoma, or a pituitary tumor removed through the skull base. Because these glands regulate metabolism, blood pressure, calcium balance, and stress hormones, patients undergoing resection typically need lifelong hormone replacement or monitoring afterward, which their care team discusses well before surgery.
Anatomy & Axis Detail
Adrenal Glands, Bilateral
Bilateral adrenalectomy removes both adrenal glands in a single operative episode, most often for ACTH-dependent Cushing disease refractory to pituitary surgery, bilateral pheochromocytomas as seen in multiple endocrine neoplasia type 2 or von Hippel-Lindau syndrome, or bilateral macronodular adrenal hyperplasia. Because the procedure eliminates all endogenous cortisol and mineralocorticoid production, patients require lifelong glucocorticoid and mineralocorticoid replacement afterward, and perioperative stress-dose steroids are essential to prevent adrenal crisis. The two sides differ anatomically, with the right gland abutting the vena cava and the left draining through the renal vein, so the operation is effectively two distinct dissections performed together, often laparoscopically or robotically. This body part value applies specifically when both glands are excised during the same operative episode, distinguishing it from staged unilateral procedures coded separately.
Approach: Open
Open approach means the surgeon cuts through skin, mucous membrane, or other tissue layers to physically expose the target site to view before performing the procedure. It gives direct visualization and hands-on access, distinguishing it from Percutaneous approaches where instruments pass through a small puncture without exposing the site. Open is typical for procedures needing wide access, such as most laparotomies.
Coding & Documentation
The operative report must confirm the entire gland was removed, not a lobe, nodule, or partial gland, since a partial removal is coded as excision instead. When a total thyroidectomy is performed in stages or as completion surgery after a prior partial removal, coders need to check whether any residual tissue remained from the earlier operation and code accordingly. A common mistake is coding bilateral adrenalectomy or parathyroidectomy as a single procedure when each gland is a separate body part value requiring its own code. Coders should also watch for cases where a resection is combined with a separate reconstructive or reconstructive-adjacent step, such as autotransplantation of a parathyroid gland fragment, which requires an additional code.