Ch. 12 Urinary and Male Reprod System

Question 1

Left ureteral stent placement and Extracorporeal Shock Wave Therapy or Lithotripsy (ESWL) of the left kidney are performed. What CPT® code(s) is/are reported for this service?

Answer 1

c.
50590-LT, 52332-51-LT

Response Feedback:
Rationale: Two procedures are performed. CPT® code 52353 describes laser lithotripsy and does not include ESWL. CPT® code 52332 describes the stent placement, but does not include the ESWL. CPT® code 50590 describes the ESWL but not the placement of the stent. CPT® code 50590 and 52332 describe both procedures performed. Modifier LT is appended to 50590 to indicate the lithotripsy was performed on the left kidney. Modifiers 51 and LT are appended to code 52332 to indicate more than one procedure was performed on the left side. Look in the CPT® Index for Lithotripsy/Kidney and Insertion/Stent/Ureteral.

Question 2

What are the filtering units of the kidney called?

Answer 2

c.
Nephrons

Response Feedback:
Rationale: The glomerulus and tubules are components of the nephrons, part of the kidney. Nephrons are the tiny filtering units of the kidney. The calyx is an extension of the renal pelvis that encloses the papilla of a renal pyramid that urine passes through from the papillary duct into the ureter.

Question 3

What is the correct CPT® code for a percutaneous pyelostolithotomy with dilation and basket extraction measuring 1 cm?

Answer 3

b. 50080
Response Feedback:
Rationale: Pyelostolithotomy/Percutaneous in the CPT® Index refers you to code range 50080-50081. Code selection is based on the size of the kidney stone (calculus). Code 50080 is a percutaneous nephrostolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, stenting, or basket extraction; up to 2 cm.

Question 4

A patient comes in for removal of a calculus from the renal pelvis via renal endoscopy through an established nephrostomy. What CPT® code is reported?

Answer 4

b. 50561
Response Feedback:
Rationale: Renal endoscopy codes are divided into two code sets: 50551-50562 and 50570-50580. The difference between the two is whether the procedure is performed through an established nephrostomy or pyelostomy or a new nephrostomy. For this scenario, the procedure is performed through an established nephrostomy. In the CPT® Index locate Endoscopy/Kidney/Removal/Calculus. Code 50561 is reported.

Question 5

What ICD-10-CM code is reported for carcinoma of the bladder dome?

Answer 5

a.
C67.1

Response Feedback:
Rationale: Neoplasm codes of the bladder, as well as other organs, are specific to site. In the ICD-10-CM Table of the Neoplasms look for Neoplasm, neoplastic/bladder (urinary)/dome and select the code from the Malignant Primary column which directs you to code C67.1. If the provider’s documentation does not report the exact location of the tumor, use the unspecified diagnosis code C67.9. Verify code selection in the Tabular List.

Question 6

A clamp circumcision is performed without dorsal block on a newborn. What CPT® code is reported for this service?

Answer 6

b.
54150-52

Response Feedback:
Rationale: The circumcision used a clamp as described in CPT® code 54150. Code 54160 describes a surgical excision other than clamp. The parenthetical note beneath 54150 says to report the code with modifier 52 when the circumcision is performed without a penile or ring block. In the CPT® Index look for Circumcision/Surgical Excision/Neonate.

Question 7

A partial cystectomy is performed due to the prior administration of radiation. It is complicated due to extensive adhesions and required an additional 2 hours beyond the usual cystectomy procedure. What CPT® code is reported for this service?

Answer 7

a.
51555

Response Feedback:
Rationale: In the CPT® Index look for Cystectomy/Partial/Complicated. The description of code 51555 is Cystectomy, partial; complicated (for example, post radiation, previous surgery, difficult location). Modifier 22 is not appended to the code as it already includes the additional work involved in the procedure.

Question 8

Patient is admitted for acute bilateral pyelonephritis. What is the appropriate ICD-10-CM code?

Answer 8

b. N10
Response Feedback:
Rationale: In the ICD-10-CM Alphabetic Index look for Pyelonephritis/acute which directs you to N10. Verify code selection in the Tabular List.

Question 9

Patient presents today for treatment of benign prostatic hypertrophy (BPH) and urinary retention by transurethral microwave thermotherapy (TUMT). What CPT® and ICD-10-CM codes are reported for this service?

Answer 9

c.
53850, N40.1, R33.8

Response Feedback:
Rationale: In the CPT® Index look for Transurethral Procedure/Prostate/Thermotherapy/Microwave which refers you to 53850. CPT® code 52648 describes laser vaporization rather than transurethral destruction of prostate tissue by microwave thermotherapy.
In the ICD-10-CM Alphabetic Index look for Enlargement, enlarged/prostate/with lower urinary tract symptoms (LUTS) directing you to code N40.1. In the Tabular List, locate N40.1 and you are directed to use additional code for associated symptoms. Code R33.8 is used to describe urinary retention. Verify code selection in the Tabular List.

Question 10

The patient is a 53-year-old male with benign prostatic hypertrophy causing urinary obstruction and requires the placement of a temporary urethral stent. What CPT® code is reported for this service?

Answer 10

a.
53855

Response Feedback:
Rationale: Urethral stents are inserted to maintain patency of the urethra. In the CPT® Index look for Stent/Placement/Ureter. CPT® code 53855 describes placement of a temporary prostatic urethral stent.

Question 11

The urologist performs a cystourethroscopy with ureteroscopy to fulgurate a ureteral lesion.
What is/are the CPT® code(s) for the procedure?

Answer 11

b. 52354
Response Feedback:
Rationale: In the CPT® Index look for Cystourethroscopy/with Fulguration/Lesion. Code choices are 52224, 52354. Code 52354 describes Cystourethroscopy, with ureteroscopy and pyeloscopy; with biopsy and fulguration of ureteral or renal pelvic lesion.

Question 12

Patient is status post radical retropubic prostatectomy with erectile dysfunction, presenting for penile implant. An inflatable penile prosthesis is inserted. What CPT® code is reported for this service?

Answer 12

b.
54401

Response Feedback:
Rationale: Penile prosthesis insertion codes are described as either noninflatable or inflatable. CPT® code 54416 is removal and replacement of an inflatable penile prosthesis. CPT® code 54408 is for repair of an inflatable penile prosthesis. Code 54400 is reported for the insertion of a noninflatable prosthesis. Code 54401 is the correct code to report for the initial insertion of an inflatable penile prosthesis. Look in the CPT® Index for Prosthesis/Penis/Insertion.

Question 13

Which statement is TRUE regarding reporting calculi in both the kidney and ureter?

Answer 13

b.
One code identifies both the calculi in the kidney and the ureter.

Response Feedback:
Rationale: ICD-10-CM has a combination code to report when there are stones (calculi) in the kidney and ureter. Look in the ICD-10-CM Alphabetic Index for Calculus, calculi, calculous/kidney/with calculus, ureter which directs you to N20.2. Verify code selection in the Tabular List.

Question 14

The patient has a 3.6 cm tumor in the lower pole of the right kidney. A percutaneous right renal cryosurgical ablation is performed. What CPT® code is reported for this service?

Answer 14

b.
50593-RT

Response Feedback:
Rationale: In the CPT® Index look for Ablation/Cryosurgical/Renal Tumor/Percutaneous and you are directed to 50593. CPT® codes 50541 and 50542 describe laparoscopic procedures and are not considered because the procedure was performed percutaneously. CPT® code 50250 is ablation of renal mass lesion(s). HCPCS Level II modifier RT is used to indicate the right side.

Question 15

Closure of exstrophy of the bladder is performed with epispadias repair. What CPT® code is reported for this service?

Answer 15

a.
54390

Response Feedback:
Rationale: In the CPT® Index look for Repair/Epispadias with code range 54380-54890. Code 54390 is for plastic operation on penis for epispadias distal to external sphincter; with exstrophy of bladder. Code 51940 is repair of the exstrophy only. Code 51860 is a cystorrhaphy, suture of bladder wound or injury. Code 51880 is the closure of a cystostomy.

Question 16

The patient presents to the office for cystometrogram (CMG). Complex CMG with voiding pressure studies is done. Intraabdominal voiding pressure studies and complex uroflowmetry are also performed. What CPT® code(s) is/are reported for this service?

Answer 16

a. 51728, 51797, 51741-51
Response Feedback:
Rationale: In the CPT® Index look for Cystometrogram directing you to 51725-51729. Code 51728 describes a Complex cystometrogram with voiding pressure studies. In the CPT® Index look for Voiding Pressure Studies/Abdominal directing you to 51797. Add-on code 51797 is used for intra-abdominal voiding pressure studies. The parenthetical directs us to use 51797 in conjunction with 51728 or 51729. Code 51741 is used to report the complex uroflowmetry. The procedures were performed in the office setting, under the direct supervision of the provider and you would not use modifier 26 for the professional component. When multiple procedures are performed in the same investigative session modifier 51 is appended.

Question 17

The patient is a very pleasant 72 year-old female noted to have bilateral nephrolithiasis. Her left stones were treated ureteroscopically. Her right stone was very large and it was treated with an ureteroscopic procedure (there were no global days). She comes in today for her second ureteroscopic procedure to remove the remaining stone fragments. Right ureteroscopy, laser lithotripsy and right ureteral stent exchange were performed. What CPT® code(s) is/are reported for this service?

Answer 17

a.
52356

Response Feedback:
Rationale: Ureteroscopic procedures have no global period and the use of modifier 58 or 76 would not be appropriate. Though a stent exchange was performed, you do not report removal of the previous stent (52310). You would report the laser lithotripsy (52356) which includes the insertion of indwelling ureteral stent (52332). In the CPT® Index, look for Lithotripsy/with Indwelling Ureteral Stent Insertion directing you to 52356. You will see a parenthetical note that indicates not to report 52332 with 52356. The insertion of the stent is included in 52356.

Question 18

Removal of a malfunctioning AMS 700 inflatable penile prosthesis and all components and implantation of an inflatable multi-component AMS Tambocor 14 mm diameter 15 mm length with 2 cm rear tip extender bilaterally in the same surgery session. What CPT® code is reported for this service?

Answer 18

d.
54410

Response Feedback:
Rationale: In the CPT® Index look for Prosthesis/Penis/Replacement for the code range. The penile prosthesis insertion, repair, removal and replacement codes are very specific. By reading the descriptions carefully you can determine the correct code to report. A repair of the prosthesis was not performed eliminating CPT® code 54408. CPT® code 54406 describes only the removal of the prosthesis. CPT ® code 54411 is the removal and replacement through an infected field which is not indicated in the question. CPT® code 54410 describes the removal and replacement of all components of a multi-component, inflatable penile prosthesis. This is not an appropriate code for a bilateral procedure and modifier 50 is not appended.

Question 19

The patient is a 68 year-old male with a recent history of urethral stenting. He had a catheter placed and had subsequent bleeding. His catheter has become clogged multiple times and CT scan shows a large clot within the urinary bladder. Informed consent was obtained. Preoperative antibiotics were administered. The patient was brought to the operating room, given a general anesthetic and prepped in the usual fashion. His urethra was intubated with a resectoscope sheath. He had a normal urethra and extremely large prostate gland. His bladder was full of clots. These were evacuated. Approximately 250mL of thick dark old clot was evacuated. After the clot was cleared there was apparently a normal bladder with no evidence of any tumors. The prostate was extremely large, and there was some bleeding from the surface. A large Coude tip 24 French hematuria catheter was then placed for continuous irrigation and there was a light pink result. The patient did well throughout the procedure. What CPT® code is reported for this service?

Answer 19

a.
52001

Response Feedback:
Rationale: Code 52001 describes a cystourethroscopy with irrigation and evacuation of multiple obstructing clots. In the CPT® Index locate Evacuation/Clots/Endoscopic. Codes 52214, 52400 and 52005 describe various procedures that were not performed.

Question 20

A 58 year-old man with an enlarging right hydrocele is here for surgical repair. He is taken to the operating room where the hydrocele was enucleated from the skin in dartos fashion and delivered into the wound. It was skeletonized at the equator and then was opened and drained. Excess hydrocele sac tissue was excised with electrocautery. It was then wrapped backward around the spermatic cord and sewn there so it would not reform. There were a few pockets also opened up and skeletonized. The testicle was replaced in the scrotum. What CPT® code is reported for this service?

Answer 20

d.
55040-RT

Response Feedback:
Rationale: A unilateral excision of a hydrocele is described with CPT® code 55040. In the CPT® Index look for Excision/Hydrocele/Tunica Vaginalis. HCPCS Level II modifier RT is used to indicate the right side. CPT® code 55000 describes puncture aspiration of hydrocele. CPT® code 55100 describes the drainage of a scrotal wall abscess.

Question 21

A 67 year-old gentleman with localized prostate cancer will be receiving brachytherapy treatment. Following calculation of the planned transrectal ultrasound, guidance was provided for percutaneous perineal placement of 1-125 seeds into the prostate tissue. What CPT® code is reported for needle placement to insert the radioactive seeds into the prostate?

Answer 21

d.
55875

Response Feedback:
Rationale: Brachytherapy is a form of radiation in which radioactive seeds or pellets are implanted directly into the tissue being treated to deliver their dose of radiation in a direct fashion and longer period of time. The placement of the seeds is performed percutaneously. The code is indexed in the CPT® Index under Prostate/Insertion/Needle guiding you to code 55875.

Question 22

Patient is a sweet 2 1/2 year-old boy with meatal stenosis. Patient is brought to the operating room and placed supine on the operating room table. After adequate general endotracheal anesthesia was accomplished, he was prepped and draped in the usual sterile fashion. A clamp was placed just inferior ventrally to his stenotic meatus after the dorsal penile block had been administered. We then cut the clamped area to allow for a widely spatulated urethral meatus. Skin edges were approximated and patient was sent to the recovery room in good condition. What CPT® code is reported for this service?

Answer 22

b.
53020

Response Feedback:
Rationale: The procedure to report is a meatotomy. In the CPT® Index look for Meatotomy/Urethral. The correct code choice is 53020 to describe the cutting of the meatus, except infant. Code 53020 is classified as a separate procedure and since this is the only procedure performed, it can be coded and stand on its own. Urethroplasty codes 53410 and 53400 are used to report reconstruction or repair of the urethra and are not meatotomy codes. Code 54161 is used for a circumcision procedure.

Question 23

Diagnosis: Bulbar urethral strictures
Procedure: Cystoscopy and dilation of urethral stricture.
Medical Necessity: A very pleasant 36 year-old male with post void hematuria.
Description: A 17 French cystoscope was introduced in the patient’s urethra up to the level of the stricture, but I was unable to pass the urethral stricture with a Super Stiff wire, so I first passed over the Glidewire, removed the cystoscope, placed a Pollock catheter over the Glidewire, and exchanged the Glidewire for a Super Stiff wire. We then removed the Pollock catheter leaving the Super Stiff wire in place as our safety wire. I dilated the patient’s urethra to 26 French without difficulty. We reintroduced the cystoscope and noted ablation of the stricture. No masses were noted within the bladder. What CPT® code(s) is/are reported for this service?

Answer 23

a.
52281

Response Feedback:
Rationale: CPT® code 52281 describes a cystoscopy with calibration and/or dilation of urethral stricture or stenosis and does not limit the coder to the type of treatment, for example Goodwin sounds, filiform, dilator, etc. In the CPT® Index look for Cystourethroscopy/Dilation/Urethra. Codes 53605 and 53620 are used for the dilation of the urethra using a method other than cystourethroscopy. Code 52000 is only the cystourethroscopy and has a separate procedure designation. Codes designated as a separate procedure should not be reported in addition to the code for the total procedure or service of which it is considered an integral component.

Question 24

Circumcision with adjacent tissue transfer was performed on a 2 month-old. What CPT® code(s) is/are reported for this service?

Answer 24

a.
14040, 54161-51

Response Feedback:
Rationale: When a circumcision is performed requiring tissue transfer or reconstruction, you report the circumcision and the tissue transfer codes. You do not append modifier 22 to the circumcision code and reporting only the tissue transfer is incorrect. Reporting repair of an incomplete circumcision is also incorrect, as we have no documentation to support a previous circumcision. In the CPT® Index look for Circumcision/Surgical Excision directing you to 54161. In the CPT® Index look for Tissue/Transfer/Adjacent/Skin directing you to 14000-14350.

Question 25

What ICD-10-CM code is reported for personal history of transitional cell carcinoma of the bladder?

Answer 25

c. Z85.51
Response Feedback:
Rationale: Look in the ICD-10-CM Alphabetic Index for History/personal (of)/malignant neoplasm/bladder which directs the coder to Z85.51. Verify code selection in the Tabular List.