Adrenal cancer is a rare type of cancer that develops in the adrenal glands that are part of the endocrine system. Also called adrenocortical cancer, it occurs when abnormal cells form in or travels to the adrenal glands and creates changes or mutations in the DNA of an adrenal gland cell. Adrenal cancer can occur at any age. However, the condition tends to affect children younger than 5 years and adults aged 40-50 years. Most growths that form in the adrenal glands are non-cancerous (benign). If left untreated, it tends to spread to other areas beyond the adrenal glands and the chances for cure become low. On the other hand, if detected at an early stage, the patient has higher chances to be cured. Administering effective treatment modalities can help delay progression or recurrence of the condition. Billing and coding for this rare type of cancer can be challenging. Endocrinologists, surgical oncologists or other specialists who treat patients with adrenal cancer need to correctly understand the usage of medical codes. Relying on the services of reputable medical billing outsourcing companies with ample expertise in this field can ensure billing and coding efficiency.

Types of Adrenal Gland Tumors

There are two main types of adrenal cortex tumors – Adenomas (benign or non-cancerous tumors) and Carcinomas (malignant or cancerous tumors).

  • Benign Adenomas– Relatively small in size – usually less than 2 inches in diameter, these adenomas generally occur in only one adrenal gland. However, in certain rare cases, they can appear in both glands. People with this condition experience no specific symptoms.
  • Adrenal Cortical Carcinomas – Compared to benign adenomas, these are larger in size (more than 2 inches in diameter). These tumors can grow large enough to press on the organs causing more specific symptoms. In certain cases, these can produce certain key hormonal changes in the body.

Generally, most types of cancers found in the adrenal gland do not begin there and hence are not adrenal cancers. Instead, they tend to begin in other organs or tissues and then spread (metastasize) through the bloodstream to the adrenal glands.

Identifying the Signs and Symptoms of Adrenal Cancer

In most cases, the signs and symptoms of adrenal cancers are caused by the excess production of hormones like – androgen, estrogen, cortisol and aldosterone. It is easier to spot these signs and symptoms in children than in adults (as physical changes become more visible during puberty). Reports suggest that in about half of people with adrenal cancer, symptoms don’t appear until the tumor is large enough to press on other organs. Women with tumors (that cause increases in androgen) may have facial hair growth or deepening of the voice. Men with tumors (that cause increases in estrogen) may experience breast enlargement or breast tenderness. Some of the common symptoms of adrenal cancers include –

  • Weight gain
  • Pink or purple stretch marks on the skin
  • Nausea and vomiting
  • Muscle cramps or weakness
  • Loss of weight without trying
  • Loss of appetite
  • Hormone changes in women that might cause excess facial hair, hair loss on the head and irregular periods
  • Hormone changes in men that might cause enlarged breast tissue and shrinking testicles
  • High blood pressure/sugar
  • Frequent urination
  • Fever
  • Back pain
  • Abdominal bloating

Diagnosing and Treating Adrenal Cancer

Adrenal cancer diagnosis begins with a previous medical history evaluation and a complete physical examination. Physicians may perform blood and urine tests to identify the unusual levels of hormones (including cortisol, aldosterone and androgens) produced by adrenal glands.

Several imaging tests – Ultrasound, CT scan, MRI scan, Positron Emission Tomography (PET) scan and Adrenal Angiography – may be requested by physicians. These imaging tests help better locate any specific growths in the adrenal glands and to distinguish whether the tumor has spread to other parts of the body- including the lungs or liver. If the physicians suspect that the adrenal gland is cancerous, they may recommend performing an image-guided fine needle biopsy. This involves removing the affected adrenal gland or a part of it for a detailed analysis in the laboratory. This can help confirm whether a person has cancer and if so, exactly what types of cells are involved.

Common treatment modalities include – surgery, chemotherapy, radiation therapy and medications. The basic goal of surgery or adrenalectomy is to remove the entire adrenal cancer – right from its roots.

On the other hand, if the tumor has spread to the nearby organ structures – like the liver or kidneys – parts or all of those organs may be removed during the surgery. Radiation therapy or chemotherapy may be performed after adrenal cancer surgery to kill cancerous cells that may remain. Medications like Mitotane (Lysodren) may be recommended after surgery to reduce the risk of cancer recurrence. In addition, it can block excessive hormone production and may help reduce the size of the tumor.

ICD-10 Codes to Report Adrenal Cancer

Billing and coding for adrenal cancer can be complex as there are several rules related to reporting the condition accurately. Physicians must report the diagnostic tests and other treatment procedures performed using the right medical codes. Medical coding services can ensure the right use of relevant codes to bill for the procedures correctly.ICD-10 diagnosis codes for adrenal cancer include –

  • C74 Malignant neoplasm of adrenal gland
    • C74.0 Malignant neoplasm of cortex of adrenal gland
      • C74.00 Malignant neoplasm of cortex of unspecified adrenal gland
      • C74.01 Malignant neoplasm of cortex of right adrenal gland
      • C74.02 Malignant neoplasm of cortex of left adrenal gland
    • C74.1 Malignant neoplasm of medulla of adrenal gland
      • C74.10 Malignant neoplasm of medulla of unspecified adrenal gland
      • C74.11 Malignant neoplasm of medulla of right adrenal gland
      • C74.12 Malignant neoplasm of medulla of left adrenal gland
    • C74.9 Malignant neoplasm of unspecified part of adrenal gland
      • C74.90 Malignant neoplasm of unspecified part of unspecified adrenal gland
      • C74.91 Malignant neoplasm of unspecified part of right adrenal gland
      • C74.92 Malignant neoplasm of unspecified part of left adrenal gland

Relieving symptoms remains an important part of medical care and treatment, if an adrenal cancer is detected. This may involve symptom management, palliative care, or supportive care. However, care for people diagnosed with adrenal tumors doesn’t end when active treatment has finished. It is important to regularly check whether the tumor has reappeared, manage any related side-effects and monitor overall health. A regular follow-up appointment with the physician is important if a person had suffered adrenal tumors in the past. This may include regular physical examinations, medical tests, or both.

As the cancer can reappear at any time, it is important to stay in close contact with the medical team. Patients must discuss their symptoms – including any new symptoms or change in symptoms that may occur at regular intervals – with their physicians.

Medical billing and coding for adrenal cancer can be complex. By utilizing medical billing services in USA from a reliable provider, healthcare practices can ensure correct and timely medical billing and claims submission.

Have you treated adrenal cancer before? If so, how was your experience aiding the patient with this illness? Was there a lot of paperwork that went along with this patient’s situation?

Jargon Buster –

Benign Adenomas – These are non-cancerous, small size tumors that generally occur in only one adrenal gland.
Adrenalectomy (Adrenal Gland Removal) – Surgery to remove one or both adrenal glands.