CPC Chapter 12- Urinary System and Male Genital System Review Questions

Question 1

Where is urine formed?
A. Kidneys
B. Renal Pelvis
C. Bladder
D. Ureters

Answer 1

A. Kidneys

Rationale: Urine is formed in the renal tubules and empties into the calyces, then into the renal pelvis of the kidney. It then travels through the ureters to the bladder.

Question 2

Urine is expelled from the body through the:
A. Ureters
B. Bladder
C. Urethra
D. Seminal Vesicles

Answer 2

C. Urethra

Rationale: The urine travels from the kidneys to the ureters, to the bladder, where it is stored until it is expelled through the urethra.

Question 3

What are the reproductive glands located in the scrotum?
A. Urethra
B. Vas Deferens
C. Seminal Vesicles
D. Testes

Answer 3

D. Testes

Rationale: The testes are the reproductive glands, the seminal vesicles contribute fluid to the ejaculatory duct, and the vas deferens transports the sperm, where it exits through the urethra.

Question 4

Which organ is not considered part of the urinary system?
A. Kidney
B. Bladder
C. Spleen
D. Urethra

Answer 4

C. Spleen

Rationale: The organs making up the urinary system consist of the kidneys, ureters, bladder, and urethra. The spleen is part of the body’s lymphatic system.

Question 5

Which gland in the male reproductive system is partly muscular and partly glandular?
A. Prostate
B. Seminal Vesicle
C. Bladder Neck
D. Testes

Answer 5

A. Prostate

Rationale: The prostate gland is the gland that is partly muscular and glandular.

Question 6

Mrs. Green is a 53-year-old woman with bilateral nephrolithiasis. What is/are the ICD-10-CM code(s)?
A. N20.1
B. N21.1
C. N20.0
D. E83.59, N29

Answer 6

C. N20.0

Rationale: Documentation of calculus of the kidney and ureter are very specific to the organ site involved. Though most stones are calcium based, coding a disorder of calcium metabolism would be incorrect. Calculus of the urethra and ureter are not correct because the documentation indicates nephrolithiasis (kidney stone). Kidney stone, or nephrolithiasis, is coded N20.0. In the ICD-10-CM Alphabetic Index, look for Calculus, calculi, calculous/kidney directing you to N20.0. Verify code selection in the Tabular List.

Question 7

Mr. Jones is an 85-year-old male who has gross hematuria, likely from a prostatic source. He has had a TURP in the past. What is the ICD-10-CM code for gross hematuria?
A. N40.0
B. R31.9
C. R31.0
D. R31.29

Answer 7

C. R31.0

Rationale: Although there is documentation that the patient previously had a TURP, there is no documentation of continuing BPH (a condition for which a TURP routinely is performed). Because documentation states gross hematuria, microscopic or unspecified hematuria would be inappropriate codes. Gross hematuria R31.0 is the correct answer. In the ICD-10-CM Alphabetic Index, look for Hematuria/gross directing you to R31.0. Verify code selection in the Tabular List.

Question 8

Jake is a 16-year-old male involved in an MVA this morning. He was the only occupant in the vehicle. No other details are available. CT examination shows the patient has a minor fractured (lacerated) right kidney. What is the ICD-10-CM code for the fractured kidney?
A. S37.001A
B. S37.091A
C. S37.041A
D. S37.011A

Answer 8

C. S37.041A

Rationale: A fractured kidney is a laceration connecting to two cortical surfaces. Look in the ICD-10-CM Alphabetic Index for Laceration/kidney/minor directing you to S37.04-. In the Tabular List, seven characters are required to complete the code. The 6th character 1 is for right kidney and the 7th character of A is for initial encounter. Complete code is S37.041A. Verify code selection in the Tabular List. A diagnosis code for the external cause also would be added for the MVA.

Question 9

The patient is a 68-year-old male with urinary retention and enlarged prostate gland. He has failed conservative treatment and presents for TURP. What is/are the ICD-10-CM code(s)?
A. N40.1, R33.8
B. R33.8, N40.1
C. N40.0
D. N41.9

Answer 9

A. N40.1, R33.8

Rationale: In the ICD-10-CM Alphabetic Index look for Enlargement, enlarged/prostate/with lower urinary symptoms (LUTS) and you are directed to N40.1. In the Tabular List there is an instructional note to Use additional code for associated symptoms, when specified. Urinary retention is coded with R33.8.

Question 10

Mr. James is an established patient with calculus in diverticulum of bladder. What is the ICD-10-CM code?
A. K57.90
B. N21.8
C. N32.3
D. N21.0

Answer 10

D. N21.0

Rationale: Looking in the ICD-10-CM Alphabetic Index in this example is critical in selecting the correct code. If you look for the main term Bladder in the Alphabetic Index it indicates to see condition. If you look for the main term Diverticulum, diverticula/bladder it directs you to code N32.3 which is diverticulum of bladder. There is a stone in the diverticulum of bladder. If you look for Calculus, calculi, calculous/bladder (diverticulum) it directs you to the code N21.0 which is the correct code. Verify code selection in the Tabular List.

Question 11

Mr. Brown presents today with a sudden onset of chills and fever with dull pain in the flank over the kidneys, which are tender when palpated. He has urgency and frequency of urination. Diagnosis is acute pyelonephritis. What is the ICD-10-CM code?
A. N12
B. N11.0
C. N11.8
D. N10

Answer 11

D. N10

Rationale: Acute pyelonephritis is coded N10, unless mention of a lesion of renal medullary necrosis is documented. Do not use chronic pyelonephritis because the documentation clearly states “acute.” Look in the ICD-10-CM Alphabetic Index for Pylonephritis/acute N10. Verify code selection in the Tabular List.

Question 12

Mr. Black is a 53-year-old male who presents today for follow up of his stress incontinence. He has been using timed voiding and Kegel exercises, but his symptoms continue. What ICD-10-CM code is reported?
A. N39.41
B. R32
C. N39.46
D. N39.3

Answer 12

D. N39.3

Rationale: Unspecified urinary incontinence is coded as R32; because documentation clearly states stress incontinence, this code would be inappropriate. Mixed urinary incontinence is a combination of urge and stress incontinence; because there is no mention of urge incontinence, codes N39.41 and N39.46 would be incorrect. Look in the ICD-10-CM Alphabetic Index for Incontinence/urine/stress (female) (male) directing you to N39.3. Verify code selection in the Tabular List.

Question 13

A 60-year-old man with prostate cancer is status post-radical prostatectomy. Prostate specific antigen (PSA) test detects high-grade disease. He is here to discuss gold fiducial marker seed placement for adjuvant radiation therapy. What is the ICD-10-CM code?
A. Z85.46
B. C61
C. D40.0
D. D49.59

Answer 13

B. C61

Rationale: Because this patient still has documented disease, Z85.46 Personal history of malignant neoplasm of prostate is incorrect. Neoplasm of unspecified behavior of other genitourinary organs, D49.59 not coded because prostate cancer is documented. Uncertain behavior of prostate neoplasm, as well as uncertain behavior of other neoplasms, should be coded only when the pathological report states uncertain. Look in the ICD-10-CM Alphabetic Index for Cancer and you are directed to see also Neoplasm, by site, malignant. In the Table of Neoplasms look for Neoplasm, neoplastic/prostate/Primary column C61. Verify code selection in the Tabular List.

Question 14

A 65-year-old woman diagnosed with a right renal tumor is status post hand-assisted laparoscopic nephrectomy. Pathology report reveals a definitive diagnosis of renal oncocytoma. What is the ICD-10-CM code?
A. D30.01
B. C64.9
C. C65.1
D. D30.11

Answer 14

A. D30.01

Rationale: Look in the ICD-10-CM Alphabetic Index for Oncocytoma, which directs you to see Neoplasm, by site, benign. Look in the Table of Neoplasms for Neoplasm, neoplastic/renal/Benign column D30.0-. In the Tabular List report 5th character 1 for right kidney. Correct code choice is D30.01.

Question 15

A 13-year-old male presents with complaints of urinary hesitancy, frequency, and dysuria. A microscopic urinalysis confirmed the presence of white blood cells (WBC), and a diagnosis of UTI is confirmed. What is the ICD-10-CM code?
A. R35.0
B. R39.11
C. R30.0
D. N39.0

Answer 15

D. N39.0

Rationale: Urinary hesitancy (R39.11), urinary frequency (R35.0) and dysuria (R30.0) are all symptoms of a urinary tract infection. Because a diagnosis of UTI was confirmed by microscopic analysis, the symptoms would not be coded. Look in the ICD-10-CM Alphabetic Index for Infection, infected, infective/urinary (tract) N39.0. Verify code selection in the Tabular List.

Question 16

A Urologist examines the urinary collecting system with a cystourethroscope and removes four bladder tumors by fulguration. Two tumors measured 1.5 cm and the other two tumors measured 2.5 cm and 3.0 cm. What code(s) should be reported?
A. 52234 X2, 52235 X2
B. 52240
C. 52234
D. 52235

Answer 16

D. 52235

Rationale: Look in the CPT® Index for Fulguration/Cystourethroscopy with/Tumor. You are referred to 52234, 52235, 52240, and 52250. When different size bladder tumors are removed in one surgical session, the code selection is based on the largest tumor size. In this example, the largest tumor removed is 3.0 cm. Only one code is reported regardless of the number of tumors removed.

Question 17

The patient presents with recurrent bladder outlet obstruction secondary to prostate enlargement and requires transurethral resection of the prostate (TURP). The patient previously had a TURP 10 years ago. What code is reported for the TURP?
A. 52601
B. 52630
C. 52648
D. 52500

Answer 17

B. 52630

Rationale: As a previous TURP was performed, CPT® 52601 is not appropriate because this code is used for the initial TURP. CPT® 52648 describes laser vaporization of the prostate, which is not the case. CPT® 52500 is described as transurethral resection of bladder neck. Because the prostate was resected, not the bladder neck, this is inappropriate. CPT® 52630 describes TURP of residual or regrowth of obstructive prostate tissue, which is the appropriate code. Look in the CPT® Index for TURP—See Prostatectomy, Transuretheral 52601, 52630. Verify in the numeric section.

Question 18

Patient presents for insertion of a draining tube due to a neurogenic bladder. The physician performs the procedure by making a small skin incision into the lower abdominal wall, then an open incision in the bladder for placement of the catheter for drainage. What CPT® code is reported?
A. 51102
B. 51040
C. 51045
D. 51705

Answer 18

B. 51040

Rationale: Aspiration of bladder with insertion of suprapubic catheter (51102) does not describe an open suprapubic tube insertion. Suprapubic catheter change is reported using CPT® 51705; therefore, this code is not reported for an insertion procedure. Because 51045 describes a ureteral catheter or stent, this code is not appropriate. CPT® 51040 Cystostomy, cystotomy with drainage describes the open suprapubic tube placement via an incision (-otomy) into the bladder. Look in the CPT® Index for Cystostomy/with Drainage 51040. Verify in the numeric section.

Question 19

Excision of urachal cyst and an incarcerated umbilical hernia repair were performed on a six-year-old male. What CPT® code is reported?
A. 49591
B. 49594
C. 49614
D. 51500

Answer 19

D. 51500

Rationale: Umbilical hernia repair codes are reported 49591-49623 and are differentiated by whether it is an intial hernia or recurrent hernia, whether the hernia is reducible, or incarcerated/strangulated, and by size. A reducible hernia is one that can be reduced to a normal position. An incarcerated or strangulated hernia is one that cannot be reduced to a normal position without surgical intervention. The description of CPT® 51500 Excision of urachal cyst or sinus, with or without umbilical hernia repair includes the umbilical hernia repair. Hernia repair is not reported separately; therefore, CPT® 51500 is the correct answer. Look in the CPT® Index for Cyst/Urachal/Bladder/Excision 51500.

Question 20

The urologist is asked by the general surgeon to place ureteral catheters for visualization of ureters during a complicated bowel surgery. Cystoscopy is performed, and ureteral catheters are inserted. The general surgeon removes the catheters at the end of the case. What CPT® code is reported?
A. 52332
B. 52005
C. 52310
D. 50605

Answer 20

B. 52005

Rationale: Placement of the ureteral catheters was performed via cystoscopy; CPT® 50605 would not be appropriate because this code is for an open insertion of indwelling stent into the ureter. CPT® 52332 describes the insertion of an indwelling ureteral stent and is not reported for temporary catheter insertion. CPT® 52310 describes the removal of a ureteral stent but does not cover the insertion of the catheters. CPT® 52005 Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation or ureteropyelography, exclusive of radiologic services is correct. There would be no additional code reported for removal of these catheters. Look in the CPT® Index for Catheterization/Cystourethroscopy/Ureteral. No modifier is used because this code includes both ureters.

Question 21

Patient presents for treatment of multiple condyloma on the penis. The excised diameter is 0.8 cm. What CPT® code is reported?
A. 11420
B. 11421
C. 11621
D. 54060

Answer 21

D. 54060

Rationale: Surgical excision of condyloma(s) of the penis is reported using CPT® 54060. Report this procedure only once because the description includes multiple condyloma excision during a single/same surgical setting. CPT® 11420 describes excision of a benign lesion of the genitalia but is not specific to condyloma and the diameter of the lesion excision is stated as 0.5 cm or less. CPT® 11421 describes a benign lesion excised from the genitalia 0.6 cm to 1.0 cm and would be appropriate had there not been a clear and concise code for condyloma excision. CPT® 11621 describes a malignant lesion excision and is not reported because there is no documentation of a malignant lesion excision. Tip: When determining the specific code to report, the body system or organ should be accessed first, before using the integumentary codes. Look in the CPT® Index for Condyloma/Penis for the range of codes.

Question 22

Patient presents for bilateral vasectomy. The vas deferens could not be located on the left side and a unilateral vasectomy is performed. The patient will be scheduled for left vasectomy under general anesthesia next week. How is the initial vasectomy reported?
A. 55250-53
B. 55250-RT
C. 55250
D. 55250-52

Answer 22

C. 55250

Rationale: CPT® 55250 is the correct code to report. No modifiers are reported with the vasectomy code because the descriptor states unilateral or bilateral. The procedure was not terminated due to the well-being of the patient (modifier 53), nor would you report a decreased service (modifier 52). Because of the code description, modifier RT is not necessary. Look in the CPT® Index for Vasectomy 55250.

Question 23

Using the scenario above, code the return to the operating room for vasectomy on the left side during the postoperative period.
A. 55250-58
B. 55250-78
C. 55250-76
D. 55250-LT

Answer 23

A. 55250-58

Rationale: Using modifier 76 on the left vasectomy is not appropriate because modifier 76 denotes a return to the operating room for a repeat procedure by the same physician during the global period. This is not a repeat procedure on the right side. Modifier 58 is appropriate because the vasectomy is a follow up to the initial vasectomy (staged or related procedure). Look in the CPT® Index for Vasectomy and refer to Appendix A for modifier 58.

Question 24

A right side epididymectomy and spermatocelectomy are performed on a 15-year-old male. What CPT® code is reported?
A. 54860
B. 54861
C. 54840
D. 54830

Answer 24

C. 54840

Rationale: Code 54840 describes the excision of spermatocele, with or without epididymectomy and is the correct code. The epididymectomy codes (58460-58461) are not reported as the procedure is included in 54840. A lesion was not removed from the epididymis, making 54830 incorrect. Look in the CPT® Index for Spermatocele/Excision 54840.

Question 25

A circumcision was performed on a newborn using a dorsal penile nerve block for anesthesia. The provider used a Plastibell for this circumcision. What CPT® code is reported?
A. 54150
B. 54160
C. 54161
D. 54150-52

Answer 25

A. 54150

Rationale: In the CPT® Index, look for Circumcision/Surgical Excision/Neonate 54150, 54160. A Plastibell is a type of device used in a circumcision. Code 54150 is correct. Modifier 52 is not required; because a dorsal penile nerve block was used. Code 54160 is specific to a surgical circumcision performed with “other than clamp or device” making this code incorrect. Code 54161 describes circumcision for a patient over the age of 28 days making this an incorrect code as well.

Question 26

When all the components in code 54405 are not performed, what modifier is reported?
A. 50
B. 52
C. 53
D. 58

Answer 26

B. 52

Rationale: Modifier 52 is used to report reduced services. There is a parenthetical under code 54405 that indicates for reduced services, report 54405 with modifier 52.

Question 27

To report a repeat procedure by the same physician, what modifier is reported?
A. 76
B. 78
C. 58
D. 79

Answer 27

A. 76

Rationale: Sometimes it is necessary for a physician to repeat a procedure. When this occurs, modifier 76 is appended.

Question 28

What modifier is appended to report the technical component of a procedure?
A. TC
B. 26
C. TC AND 26
D. None of the above

Answer 28

A. TC

Rationale: Some CPT® codes have a technical component and a professional component. Modifier 26 is appended when the professional component is provided, and modifier TC is appended when the technical component is provided. Professional services are those in which the physician performs supervision and interpretation with report. Technical services include ownership of the equipment, space, and employment of the technicians or nurses who performed the study.

Question 29

What modifier is appended to report a bilateral procedure?
A. 51
B. 50
C. RT AND LT
D. B and C

Answer 29

D. B and C

Rationale: Depending upon the insurer, either modifier 50 or RT and LT is appended to the surgical procedure.

Question 30

When a procedure is terminated due to circumstances that threaten the well-being of the patient, which modifier is appended to the procedure code?
A. 52
B. 53
C. 54
D. 26

Answer 30

B. 53

Rationale: When a procedure is terminated to preserve the well-being of the patient, modifier 53 is appended to the procedure code.

Question 31

Transurethral resection of a medium-size (3.0 cm) bladder tumor was performed in an outpatient setting. What CPT® code is reported for this service?
A. 52234
B. 52224
C. 52240
D. 52235

Answer 31

D. 52235

Rationale: Transurethral resection of bladder tumors are coded by the size of the tumor; less than 0.5 cm (52224), 0.5 cm- up to 2.0 cm (52234), 2.0 cm up to 5.0 cm (52235), 5.0 cm or larger (52240). In the CPT® Index see Resection/Tumor/Bladder or Tumor/Bladder.

Question 32

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?
A. 50590-LT
B. 52332-LT
C. 52353-LT
D. 50590-LT, 52332-51-LT

Answer 32

D. 50590-LT, 52332-51-LT

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® codes 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 33

The urologist is called to the operating room to repair a kidney laceration status post MVA. The urologist examines the kidney and repairs a small 2 cm laceration of the kidney. What CPT® code is reported for this service?
A. 50526
B. 50500
C. 50525
D. 50520

Answer 33

B. 50500

Rationale: Kidney repair or nephrorrhaphy codes are reported with CPT® codes 50400-50540. CPT® code 50500 clearly states repair of kidney laceration. Tip: You do not use the integumentary codes, but look at the repair codes listed within each body/organ system of the CPT® code book. In the CPT® Index see Repair/Kidney/Wound.

Question 34

What are the reproductive glands that produce male hormones?
A. Vas Deferens
B. Spermatic Cord
C. Epididymis
D. Testes

Answer 34

D. Testes

Rationale: Testes are the male reproductive glands and produce testosterone.

Question 35

What ICD-10 -CM code is reported for carcinoma of the bladder dome?
A. C67.3
B. C67.1
C. C67.5
D. C67.9

Answer 35

B. C67.1

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 36

The urologist performs a cystourethroscopy with ureteroscopy to fulgurate a ureteral lesion. What is/are the CPT® code(s) for the procedure?
A. 52330
B. 52354, 52330-51
C. 52354
D. 52325

Answer 36

C. 52354

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 37

A fracture of the corpus cavernosum penis is repaired. What is the correct code?
A. 54420
B. 54430
C. 54440
D. 54435

Answer 37

C. 54440

Rationale: Repair for penile injury is reported using CPT® code 54440. Do not report CPT® codes used for treatment of priapism when there is injury to the penis. In the CPT® Index look for Repair/Penis/Injury.

Question 38

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?
A. 52648, N40.1, R33.8
B. 53850, N40.1, R33.8
C. 52648, N40.1
D. 53850, N40.0, R33.8

Answer 38

B. 53850, N40.1, R33.8

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 39

A clamp circumcision is performed without dorsal block on a newborn. What CPT® code is reported for this service?
A. 54150-52
B. 54160
C. 54150
D. 54160-52

Answer 39

A. 54150-52

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 40

Vasectomy reversal is performed, bilaterally, using the operating microscope. Choose the procedure code(s).
A. 55250-50, 69990
B. 55250
C. 55400
D. 55400-50, 69990

Answer 40

D. 55400-50, 69990

Rationale: In the CPT® Index look for Vasectomy/Reversal which refers you to see Vasovasorrhaphy directing you to code 55400. There are two parenthetical instructions beneath the code instructing us to use modifier 50 for a bilateral procedure and to use 69990 when an operating microscope is used.

Question 41

In ICD-10-CM when both CKD and ESRD are reported what code(s) is/are reported?
A. N18.5, N18.6
B. N18.6, N18.5
C. N18.5
D. N18.6

Answer 41

D. N18.6

Rationale: Kidney or renal failure can be acute N17 or chronic N18. Chronic kidney disease (CKD) is classified in ICD-10-CM by severity (N18). The severity of CKD is designated by stages 1-5 (N18.1-N18.5). Code N18.6 for End stage renal disease (ESRD) is reported when documentation supports ESRD. If both CKD and ESRD are supported by the documentation, only N18.6 is reported as supported by the Excludes1 note under N18.5. Look in the ICD-10-CM Alphabetic Index for Disease/end stage renal which directs you to N18.6. Verify code selection in the Tabular List.

Question 42

When a cystectomy is performed, there are various means of diverting the urine. One method is to create a neobladder which allows the patient to void through his or her urethra. Which code describes this procedure?
A. 51580
B. 51596
C. 51590
D. 51595

Answer 42

B. 51596

Rationale: Creation of a neobladder allows the patient the ability to void through the urethra and is reported with 51596. In CPT® code 51580 an -ostomy is created and urine is emptied into an appliance bag. In CPT® code 51590 a catheter is placed and used to remove urine from the body. Look in the CPT® Index for Neobladder/Construction.

Question 43

A 63-year-old gentleman comes into the ED complaining of the urge to urinate but has been unable to empty his bladder. The provider decides to place a Foley catheter to relieve the urine retention due to prostate hypertrophy. What is the code selection for the procedure and diagnosis codes?
A. 51701, N40.1, R33.9
B. 51702, N40.1, R33.8
C. 51701, R33.8, N40.1
D. 51702, R33.9, N40.1

Answer 43

B. 51702, N40.1, R33.8

Rationale: In the CPT® Index look for Catheter/Bladder referring you to codes 51701-51703. CPT® code 51702 is correct to report for this scenario since an indwelling catheter (for example a Foley catheter) is left in the bladder and urine is drained. Code 51701 is used when a non-indwelling catheter is inserted to determine post void residual urine; this is sometimes called a straight cath.
The patient is diagnosed with urine retention and prostate hypertrophy. In the ICD-10-CM Alphabetic Index look for Enlargement, enlarged/prostate/with lower urinary retention guiding 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 44

Patient is a 68-year-old male admitted for left flank nephrectomy with partial ureterectomy. He has left renal atrophy and chronic renal inflammation. The pathology report reveals marked glomerulosclerosis, chronic inflammation of the kidney, renal pelvis and ureter. What CPT® and ICD-10-CM codes are reported for this service?
A. 50220-LT, N26.9, N28.89
B. 50230-LT, N00.9, N26.9
C. 50230-LT, N03.9, N26.9
D. 50220-LT, N05.1, N29

Answer 44

A. 50220-LT, N26.9, N28.89

Rationale: In the CPT® Index look for Nephrectomy/with Ureters. CPT® code 50220 describes the nephrectomy including a partial ureterectomy. CPT® code 50230 describes a radical nephrectomy procedure with regional lymphadenectomy, and in this case, there is no documentation to support a radical procedure. HCPCS Level II modifier LT is used to indicate the left side.
In the ICD-10-CM Alphabetic Index look for Glomerulosclerosis directing you to see also Sclerosis, renal. Look for Sclerosis, sclerotic/renal directing you to N26.9. To find inflammation of the ureter, look in the ICD-10-CM Alphabetic Index for Ureteritis referring you to N28.89. Verify all code selections in the Tabular List.

Question 45

Patient is admitted for acute bilateral pyelonephritis. What is the appropriate ICD-10-CM code?
A. N11.1
B. N11.8
C. N11.9
D. N10

Answer 45

D. N10

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 46

Preoperative diagnosis: Cytologic atypia and gross hematuria
Postoperative diagnosis: Cytologic atypia and gross hematuria
Procedure performed: Cystoscopy and random bladder biopsies and GreenLight laser ablation of the prostate.
Description: Bladder biopsies were taken of the dome, posterior bladder wall and lateral side walls. Bugbee was used to fulgurate the biopsy sites to diminish bleeding. Cystoscope was replaced with the cystoscope designed for the GreenLight laser. We introduced this into the patient’s urethra and performed GreenLight laser ablation of the prostate down to the level of verumontanum on, the prostatic crest near the wall of the urethra. There were some calcifications at the left apex of the prostate, causing damage to the laser but adequate vaporization was achieved. What CPT® code(s) is/are reported for this service?
A. 52648, 52224-59
B. 52647
C. 52648, 52204
D. 52649, 52224-59

Answer 46

A. 52648, 52224-59

Rationale: Laser vaporization is reported using CPT® code 52648. In the CPT® Index look for Prostate/Vaporization/Laser directing you to 52648. A biopsy is usually not reported at the same time of the laser procedure. In this case, the operative report clearly states that this procedure is a distinct procedure; it is a different procedure from the GreenLight laser ablation and is reported separately using modifier 59. CPT® code 52224 describes cystourethroscopy, with fulguration, with or without biopsy. In the CPT® Index look for Cystourethroscopy/Biopsy.

Question 47

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?
A. 51728, 51797, 51741-51
B. 51726, 51728-51, 51797
C. 51726
D. 51728-26, 51797-26, 51741-51-26

Answer 47

A. 51728, 51797, 61741-51

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 48

Patient is a 67-year-old male with chronic orchialgia following a right inguinal hernia repair. He is admitted for scrotal exploration and simple orchiectomy. The patient is brought to the operating room and placed supine on the operating table. After adequate anesthesia was accomplished, he was prepped and draped in the usual sterile fashion; 0.25% Marcaine plain was infused in the skin along his median rhaphe and a 4 cm median rhaphe incision was made. We dissected into his right hemiscrotum and identified his right testis which was small and atrophic. The spermatic cord was identified and separated into 2 sections each section was double tied with #1 silk suture. The testis was then transected from the spermatic cord, distal to the sutures and no bleeding was noted from the stump of the spermatic cord. Scrotal skin was closed in two layers, the first layer with a running stitch of 3-0 Monocryl and the second was a 3-0 chromic in the horizontal mattress. Dermabond was applied over the incision. He was extubated and taken to the recovery room in good condition. What CPT® code(s) is/are reported for this service?
A. 54530
B. 54520
C. 54520, 12044
D. 54522

Answer 48

B. 54520

Rationale: The procedure is a simple orchiectomy with only the removal of the testis. The closure of a surgical incision in included in the procedure code and usually not reported separately. In the CPT® Index look for Orchiectomy/Simple. CPT® code 54530 describes a radical orchiectomy which is the removal of the testis and all associated structures. CPT® code 54522 describes the partial excision of one or both testis.

Question 49

What ICD-10-CM code is reported for Phimosis?
A. N47.1
B. N47.8
C. A57
D. N47.2

Answer 49

A. N47.1

Rationale: Look in the ICD-10-CM Alphabetic Index for Phimosis which directs you to N47.1. Verify code selection in the Tabular List.

Question 50

Benign prostatic hypertrophy with outlet obstruction and hematuria.
Operation: TURP
Anesthesia: Spinal
Description of procedure: The patient was placed on the operating room table in a sitting position and spinal anesthesia induced. He was placed in the lithotomy position, prepped and draped appropriately. Resection began at the posterior bladder neck and extended to the verumontanum (a crest near the wall of the urethra). Posterior tissue was resected first from the left lateral lobe, then right lateral lobe, then anterior. Depth of resection was carried to the level of the circular fibers. Bleeding vessels were electrocauterized as encountered. Care was taken to not resect distal to the verumontanum, thus protecting the external sphincter. At the end of the procedure, prostatic chips were evacuated from the bladder. Final inspection showed good hemostasis and intact verumontanum. The instruments were removed, Foley catheter inserted and the patient returned to the recovery area in satisfactory condition. What CPT® code is reported for this service?
A. 52630
B. 52601-50
C. 52640
D. 52601

Answer 50

D. 52601

Rationale: TURP is a Transurethral Resection of the Prostate and reported with 52601. In the CPT® Index, TURP directs you to See Prostatectomy, Transurethral. Prostatectomy/Transurethral directs you to 52601, 52630. A TURP is not a bilateral procedure and is not reported with modifier 50. Code 52630 is reported when it is done for residual or regrowth of the obstructive prostate tissue. Code 52640 describes postoperative procedures on the bladder neck.

Question 51

The patient is a very pleasant 72-year-old female noted to have bilateral nephrolithiasis. The stones on her left were treated ureteroscopically. Her right stone was very large and 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?
A. 52356
B. 52356-58, 52332-58
C. 52353-76, 52332-76
D. 52353, 52310-51, 52332-51

Answer 51

A. 52356

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 52

Patient comes in today to the provider’s office for routine monthly Foley catheter change. A two-way Foley catheter is replaced in the usual sterile fashion. A vinyl abdominal urinary drainage bag and bedside bag are given to the patient. What is/are the correct code(s)?
A. 51702, A4338, A4357, A4358
B. 51102
C. 51701, A4338, A4357, A4358
D. 51100

Answer 52

A. 51702, A4338, A4357, A4358

Rationale: Routine catheter changes are coded using the insertion of temporary indwelling catheter code 51702. In the CPT® Index look for Catheter/Bladder for the code range 51701-51703. Code 51701 is used for a non-indwelling catheter. Codes 51100 and 51102 describe the aspiration of the bladder by needle or catheter. In addition to reporting the catheter insertion, you report the dispensed supplies from the HCPCS Level II book. In the HCPCS Index, look for Foley catheter and you are referred to codes A4312-A4316, A4338-A4346. Reviewing the Tabular Index, code A4338 is correct for Indwelling catheter; Foley type, 2-way latex with coating (Teflon, silicone, silicone elastomer, or hydrophilic, etc.), each. Next, review the HCPCS Index for Drainage / Bag / Bedside which refers you to code A4357 and Drainage / Bag / Urinary, vinyl which refers you to code A4358. Confirm both codes in the tabular.

Question 53

Cystoscopy, left ureteroscopy, holmium laser lithotripsy, stone manipulation, stent removal and replacement are performed. The holmium laser was used to break up a cluster of stones at the ureteropelvic (UP) junction which were removed with a basket and a Gibbons stent was exchanged. Previous CT scan showed stones in the lower right pole. It was decided to proceed with ureteroscopy. Ureteroscope was inserted in the right ureter, confirming multiple stones within the proximal ureter. These were basketed and removed. What CPT® codes are reported for this service?
A. 52353-LT, 52353-59-RT
B. 52353-LT, 52352-59-RT, 52332-51-LT
C. 52356-LT, 52352-59-RT
D. 52310, 52353-51, 52352-59

Answer 53

C. 52356-LT, 52352-59-RT

Rationale: When a stent is removed and replaced, the removal of the initial stent is included in the stent replacement and is not reported. One code is reported for performing the lithotripsy and replacement of the stent in the left ureter. In the CPT® Index look for Lithotripsy/with indwelling Ureteral Stent Insertion directing you to 52356. Modifier LT is reported for the left ureter. Usually the basketing of the stones is included with the laser lithotripsy; however, because basketing of stones is performed on a different ureter (RT) than the laser lithotripsy (LT), to report CPT® code 52352 with modifiers 59 and RT. In the CPT® Index, look for Cystourethroscopy/Removal/Calculus referring you to 52352.

Question 54

The patient has significant morbid obesity and her pannus has been retracted to help with dissection. The planned procedure is to place a catheter/tube to drain the bladder. It is apparent she has quite a bit of scarring from her previous surgeries and appears to have an old sinus tract just above the symphysis. A midline incision is made following her old scar from just above the symphysis for a length of about 4-6cm. The sinus tract was excised, as this was also in the midline, and carefully dissected down to the level of the fascia. It does not appear to be an actual hernia, as there are no ventral contents within it. Again, there is quite a bit of distortion from previous scarring because of the obesity, but staying in the midline, the fascia is incised just above the symphysis of a length of about 2cm. The fat and scar are incised above the fascia more superiorly and with palpation, mesh from a previous hernia repair is felt. This was not palpable prior to the incision because of her body habitus. The mesh was not exposed or entered, it comes down quite close to the symphysis and certainly is too close to place a suprapubic (SP) tube. There is concern the mesh may become infected with an SP tube tract right there. Therefore, decision to abort the procedure is made. What CPT® code and modifier are reported for this service?
A. 51040-52
B. 51102-53
C. 51040-53
D. 51050-52

Answer 54

C. 51040-53

Rationale: The intended procedure is cystostomy. In the CPT® Index look for Cystostomy/with Drainage. Modifier 53 is appended when the procedure is terminated due to the well-being of the patient and is appended to the initial procedure intended. CPT® code 51102 describes insertion of a suprapubic catheter by aspiration of the bladder; this is not the correct code to report.

Question 55

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?
A. 54161
B. 53410
C. 53400
D. 53020

Answer 55

D. 53020

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.