Urinary system, male and female genital system (50000)

1. A patient had a renal auto-transplantation extracorporeal surgery, re-

implantation of a kidney, and a partial nephrectomy. How would you report this
procedure?
a. 50340, 50380, 50240-51
b. 50543, 50370-52
c. 50380, 50240-51
d. 50380, 50240-59

2. Bill, a 52-year-old male patient, was admitted to the hospital and treated for
prostatic malignancy. His doctor dictated a detailed history, detailed exam, and
straightforward medical decision-making for admission. He was treated with
interstitial transperineal prostate brachytherapy, including implantation of 51
iodine-125 seeds. His doctor visited him the day after the procedure. How would
you report the professional service by the therapeutic radiologist who did both
the implantation and brachytherapy?
a. 99222, 55876, 77763 x 51
b. 55875, 77778
c. 99221, 58715, 77783
d. 58346, 77799 x 125

3. Harry had a couple of stones in both kidneys. He was taken into the lithotripsy
unit and placed on the lithotripsy table in a supine position with the induction of
anesthesia. The stones were well visualized and the patient received a total of
3,500 shocks with a maximum power setting of 3.0. The treatment was successful.
How would you report this procedure?
a. 50590
b. 50561
c. 50060
d. 50080

4. Tom was placed under general anesthesia (by an anesthesiologist) for an

excision of a local lesion of the epididymis. How would you report the surgeon’s
services?
a. 54861-50
b. 54860-47
c. 54830, 00920-51
d. 54830

5. Alex suffered several injuries to his upper leg muscles and penis when he fell
onto the bar of his touring bicycle. The day of the accident, Dr. Green completed
muscle repair surgery to Alex’s upper legs. Today, three days after the leg
surgeries, Dr. Green took Alex back to the operating suite to complete an
unrelated repair to the penis. Dr. Green completed a plastic repair to correct the
penal injury. What code(s) would capture today’s procedure?
a. 54440-79
b. 27385, 54440-59
c. 27393, 54620-79
d. 54440-26

6. Heather had a bilateral laparoscopic occlusion of her fallopian tubes using a

Falope ring. How would you report this procedure?
a. 58615
b. 58671
c. 58671-50
d. 58679-50

7. A 65-year-old male patient has an indwelling nephroureteral double-J stent

tube replaced to treat a ureteral obstruction caused by a stricture from
postoperative scarring. His stent tube is exchanged every two months to prevent
occlusion in the stent, UTI, and loss of kidney function. Dr. Mott did this
procedure via a transurethral approach under conscious sedation and provided
the radiological supervision and interpretation. How would you report this
procedure?
a. 50605, 50382
b. 50385, 52283, 99143
c. 50385
d. 0084T

8. Dr. Blue provided interpretation and results for a needle electromyography for
anal sphincter function. How would you report this service?
a. 51784
b. 51784, 51785-51
c. 55875
d. 51785-26
9. A 48-year-old patient with BPH has his prostate removed via a laser
enucleation. During this procedure he also has a vasectomy. What code(s) would
report this procedure?
a. 52648
b. 52649
c. 52649, 55250-51
d. 52647

10. What code series would you refer to for patients who have had a previous
cesarean delivery and now present with the expectation of a vaginal delivery?
a. 59400–59141
b. 59618–59622
c. 59610–59614
d. 59610–59622

11. How would you report a bilateral cadaver donor nephrectomy with cold
preservation?
a. 50300-50
b. 50320-50
c. 50234
d. 50300

12. 45-year-old male is going to donate his kidney to his son. Operating ports
where placed in standard position and the scope was inserted. Dissection of the
renal artery and vein was performed isolating the kidney. The kidney was
suspended only by the renal artery and vein as well as the ureter. A stapler was
used to divide the vein just above the aorta and three clips across the ureter,
extracting the kidney. This was placed on ice and sent to the recipient room. The
correct CPT code is:
A. 50543 B. 50547 C. 50300 D. 50320

13. 67-year-old female having urinary incontinence with intrinsic sphincter

deficiency is having a cystoscopy performed with a placement of a sling. An
incision was made over the mid urethra dissected laterally to urethropelvic
ligament. Cystoscopy revealed no penetration of the bladder. The edges of the
sling were weaved around the junction of the urethra and brought up to the
suprapubic incision. A hemostat was then placed between the sling and the
urethra, ensuring no tension. What code should be used for this procedure?

A. 57288 B. 57287 C. 52000, 57288 D. 52000, 51992

14. 16-day-year old male baby is in the OR for a repeat circumcision due to
redundant foreskin that caused circumferential scarring from the original
circumcision. Anesthetic was injected and an incision was made at base of the
foreskin. Foreskin was pulled back and the excess foreskin was taken off and the
two raw skin surfaces were sutured together to create a circumferential
anastomosis. Select the appropriate code for this surgery:

A. 54150 B. 54160 C. 54163 D. 54164

15. 5-year-old female has a history of post void dribbling. She was found to have
extensive labial adhesions, which have been unresponsive to topical medical
management. She is brought to the operating suite in a supine position. Under
general anesthesia the labia majora is retracted and the granulating chronic
adhesions were incised midline both anteriorly and posteriorly. The adherent
granulation tissue was excised on either side. What code should be used for this
procedure?

A. 58660 B. 58740 C. 57061 D. 56441

16. 5-year-old male with a history of prematurity was found to have penile
curvature, congenital hypospadias. He presents for surgical management for
straightening the curvature. Under general anesthesia, bands were placed around
the base of the penis and incisions were made degloving the penis
circumferentially. The foreskin was divided in Byers flaps and the penile skin was
reapproximated at the 12 o’clock position. Two Byers flaps were reapproximated,
recreating a mucosal collar which was then criss- crossed and trimmed in the
midline in order to accommodate median raphe reconstruction. This was
reconstructed with use of a horizontal mattress suture. The shaft skin was then
approximated to the mucosal collar with sutures correcting the defect. Which CPT
code should be used?
A. 54304
B. 54340
C. 54360
D. 54440

17. The patient is a 22-year-old who was found to be 7-1/2 weeks pregnant. She
has consented for a D&E .She was brought to the operating room where MAC
anesthesia was given. She was then placed in the dorsal lithotomy position and a
weighted speculum was placed into her posterior vaginal vault. Cervix was
identified and dilated. A 6.5-cm suction catheter hooked up to a suction
evacuator was placed and products of conception were evacuated. A medium size
curette was then used to curette her endometrium. There was noted to be a small
amount of remaining products of conception in her left cornua. Once again the
suction evacuator was placed and the remaining products of conception were
evacuated. At this point she had a good endometrial curetting with no further
products of conception noted. Which CPT code should be used?
A. 59840
B. 59841
C. 59812
D. 59851

18. A 37-year-old female has menorrhagia and wants permanent sterilization. The
patient was placed in Allen stirrups in the operating room. Under anesthesia the
cervix was dilated and the hysteroscope was advanced to the endometrium into
the uterine cavity. No polyps or fibroids were seen. The Novasure was used for
endometrial ablation. A knife was then used to make an incision in the right lower
quadrant and left lower quadrant with 5-mm trocars inserted under direct
visualization with no injury to any abdominal contents. Laparoscopic findings
revealed the uterus, ovaries and fallopian tubes to be normal. The appendix was
normal as were the upper quadrants. Because of the patient's history of breast
cancer and desire for no further children, it was decided to take out both the
tubes and ovaries. This had been discussed with the patient prior to surgery.
What are the codes for these procedures?
A. 58660, 58353
B. 58661,58563-51
C. 58661, 58558
D. 58662, 58563-51
19. This gentleman has localized prostate cancer and has chosen to have
complete transrectal ultrasonography performed for dosimetry purposes.
Following calculation of the planned transrectal ultrasound, guidance was
provided for percutaneous placement of 1-125 seeds. Select the appropriate
codes for this procedure.
A. 55860, 76942-26
B. 55875, 76965-26
C. 55860, 76873-26
D. 55875, 77778-26, 76965-26
Question 115
20. -year-old female in the OR for ectopic pregnancy. Once the trocars were place
a pneumoperitoneum was created and the laparoscope introduced. The left
fallopian tube was dilated and was bleeding. The left ovary was normal. The
uterus was of normal size, shape and contour. The right ovary and tube were
normal. Due to the patient’s body habitus the adnexa could not be visualized to
start the surgery. At this point the laparoscopic approach was terminated. The
pneumoperitoneum was deflated, and trocar sites were sutured closed. The
trocars and laparoscopic instruments had been removed. Open surgery was
performed incising a previous transverse scar from a cesarean section. The
gestation site was bleeding and all products of conception and clots were
removed. The left tube was grasped, clamped and removed in its entirety and
passed off to pathology. What code(s) should be used for this procedure?
A. 59150, 59120
B. 59151
C. 59121
D. 59120
21. 23-year-old who is pregnant at 39 weeks and 3 days is presenting for a low
transverse cesarean section. An abdominal incision is made and was extended
superiorly and inferiorly with good visualization of the bladder. The bladder blade
was then inserted and the lower uterine segment incised in a transverse fashion
with the scalpel. The bladder blade was removed and the infant's head delivered
atraumatically. The nose and mouth were suctioned with the bulb suction trap
and the cord doubly clamped and cut. The placenta was then removed manually.
What code should be reported for this procedure?
A. 59610, 654.21, V27.0
B. 59510, 669.61, V27.0
C. 59514, 669.71, V27.0
D. 59515, 669.71, V27.0

22 . 55-year-old female has a symptomatic rectocele. She had been admitted and
taken to the main OR. An incision is made in the vagina into the perineal body
(central tendon of the perineum). Dissection was carried underneath posterior
vaginal epithelium all the way over to the rectocele. Fascial tissue was brought
together with sutures creating a bridge and the rectocele had been reduced with
good support between the vagina and rectum. What procedure code should be
reported?
A. 45560
B. 57284
C. 57250
D. 57240
23. A pregnant patient delivers twins at 30 weeks gestation. The first baby is
delivered vaginally, but during this delivery, the second baby has turned into the
transverse position during labor. The decision is made to perform a cesarean to
deliver the second baby. The OB physician who performed the delivery also
performed the prenatal care. The standard coding for this is:
A. 59400, 59514-51, 651.01, 652.31
B. 59510, 59409-51, 651.01, 652.31
C. 59510-22, 651.01, 660.01, 652.31
D. 59510, 59409-51, 651.01, 660.30

24. A 30-year-old disabled Medicare patient is scheduled for surgery due to the
finding of what looks like an ovarian mass on the right ovary. On entering the
abdomen, the surgeon finds an enlarged ovarian cyst on the right, but the ovary is
otherwise normal. The left ovary is necrotic looking. The decision is made, based
on the patient’s age, to remove the cyst from the right ovary, but performs a left
salpingo-oophorectomy. Code this encounter.
A. 58720-RT, 58925-LT B. 58925-RT, 58720-51-LT
C. 58925, 58720-50 D. 58720, 58925-51

25. 35-year-old male patient presented to an urologist because he was having

continuous yeast infections and irritation on his penis. The physician
recommended he have a circumcision. The physician performed the circumcision
using a clamp with regional block. Code this procedure.
A. 54150 B. 54160
C. 54161 D. 54150-52

26. A 55-year-old man with complaints of an elevated PSA of 6.5 presents to the
outpatient surgical facility for prostate biopsies. The patient is placed in the
lateral position. Some calcifications were found in the right lobe, with no obvious
hypoechogenic abnormality. The base of the prostate was infiltrated and under
ultrasonic guidance random needle biopsies were performed.
A. 55700, 76872-26 B. 55706
C. 55700, 76942-26 D. 55700
27. A colposcope was introduced into the patient’s vagina and under direct
visualization through a binocular microscope excessive lesions were revealed in
and around the vagina. Electrocautery and laser vaporization were used to
destroy the extensive number of vaginal lesions. What are the procedure and
diagnosis codes?
A. 57061, 623.8 B. 57065, 623.8
C. 57000, 621.9 D. 57120, 621.9

28. A pregnant patient is diagnosed with an incompetent cervix. The physician

performs a cervical cerclage to prevent a missed abortion. After inserting a
speculum into the vagina to view the cervix, the physician threads heavy suture
material around the cervix using purse-string sutures. The sutures are pulled tight
to make the opening smaller and prevent spontaneous abortion. What are the
procedure and diagnosis codes?
A. 57700, 654.50 B. 59320, 654.53
C. 59325, 622.5 D. 59899, 622.5
29. A patient is diagnosed with a bladder tumor. The physician performs a
cystourethroscopy with fulguration and resects a 7 cm bladder tumor. Which
CPT® code(s) would you use for this service?
A. 52000, 52235 B. 52000, 52240
C. 52240 D. 52204, 52240
30. The patient has a positive pregnancy test, but ultrasound does not confirm a
gestational sac in the first trimester. The physician diagnoses a blighted ovum and
performs a suction D&C. What are the procedure and diagnosis codes?
A. 59870, 631 B. 59820, 631
C. 58120, 631 D. 59840, 631

31. The physician performs a cystoscopy, bilateral retrograde pyelograms,

removal of stent, and ureteroscopy on the left side at a hospital. DESCRIPTION:
After satisfactory general anesthesia, and after routine preparation and draping in
the lithotomy position. The urethra seemed to be free of lesions. There was no
prostatic tissue. The bladder had two diverticula, one right end one left
inferolateral wall, no lesions were noted, and the right was larger. Urine for
cytology and FISH was sent. Residual urine was approximately 100 mL. Ureteral
stent was seen in the left ureter. Right retrograde ureterogram revealed no
lesions. The bladder was free of lesions. The stent was removed easily on the left
side, and ureteroscopy was carried out into the renal pelvis with no lesions noted.
Right retrograde pyelogram then revealed grade II-III dilatation of the ureter,
grade I dilatation of the calices on the left side, and no other lesions. It was
decided not to replace the double-J stent. The patient tolerated the procedure
well and was sent to the RR in good condition. How would you code the
procedure?
A. 52310, 74420-26 B. 52332, 52000-59, 74420-26
C. 52310, 52000, 74425-26 D. 52332, 52310, 74425-26

32. A laparoscopic removal of the patient’s left testicle was performed on a 34-
year-old patient who was diagnosed with testicular cancer. Code the encounter.
A. 54522, 186.0 B. 58671, 257.8
C. 54640, 257.8 D. 54690, 186.9
33. A patient had three needle biopsies of the prostate completed under imaging
and guidance. Which codes capture the professional services for this procedure?
a. 55700 x 3, 76942-26
b. 10022, 55700 x 3, 76942-26
c. 55700, 76942-26
d. 55705 x 3, 10022, 76942-26
34. A Newborn baby boy Martinez underwent a procedure to slit the prepuce to
relieve constriction that prevented retraction of the foreskin over the head of the
penis. The slit tissue was sutured at the divided skin to control bleeding. The
patient tolerated the procedure well. How would Dr. David report his services for
this procedure?
a. 54000-63
b. 54000
c. 54001-52
d. 54001-63
35. A patient underwent destruction of extensive condyloma lesions on the penis.
The documentation stated 12 or more lesions were visible and treated during this
session. The procedure was completed by laser technique. The patient received
follow-up and post-procedure care instructions and was discharged in good
condition. How should you report this procedure?
a. 54057 x 12, 54065-59
b. 54065 x 12
c. 54057-22
d. 54065
36. A patient underwent an injection procedure for voiding urethrocystography
with contrast. During the same investigative session, the physician completed all
components of a urethral pressure profile study and a simple UFR including
interpretation of the results. How should you report the professional services for
this procedure?
a. 51600, 74455-26, 51727-51, 51736-51
b. 51605, 74430-26, 51727-26, 51741-51
c. 51600, 74430-26, 51727-26, 51797-51
d. 51605, 74455-TC, 51727-26, 51736-51
37. A physician completed a cystourethroscopy with insertion of two permanent
urethral stents. How should you report this?
a. 53855 x 2
b. 52282 x 2
c. 52281, 53855-59
d. 52282 x 2, 52305-59
38. What modifier should be reported with the procedure code for transurethral
resection of residual, or regrowth of, obstructive prostate tissue when the
procedure is performed by the same physician during a postoperative period?
a. -22
b. -52
c. -77
d. -78
39. Dr. Laura completed a vaginal delivery in the hospital for Stephanie, a 30-year-
old patient. This is Stephanie’s first child and she delivered a healthy baby boy. Dr.
Laura has taken care of Stephanie during the entire pregnancy and followed her
through the postpartum period. Dr. Laura’s documentation stated that during the
delivery admission, Stephanie required prophylactic antibiotics because she has
mitral valve prolapse. How should Dr. Laura report the delivery care and diagnosis
for this patient?
a. 650, 424.0, V30.0, 59400
b. 424.0, 424.0, V30.0, 59510
c. 648.61, 424.0, V27.0, 59400
d. 414.0, 648.61, V27.0, 59614
40. Diane suffered a spontaneous incomplete miscarriage during the second
trimester and required surgical completion of this event. How should this
procedure be reported?
a. 59812
b. 59820
c. 59821
d. 59840
41. An established patient required medical attention for removal of an impacted
foreign body from the vaginal canal. Her physician documented a detailed history,
detailed examination including enlargement of the vaginal opening with
introduction of speculum, and identification of the foreign body as a tampon. The
patient was asked to return to the office if she had any complications, fever, or
abnormal discharge or heavy bleeding. How should you report the procedure?
a. 99214-25, 57415
b. 99214
c. 57415
d. 57415-52
42. One week ago, Marion underwent a surgical laparoscopy with vaginal
hysterectomy including removal of a 275-g uterus tube and ovaries due to cancer
of the endometrium. Today she was admitted for a planned insertion of a vaginal
radiation afterloading apparatus for clinical brachytherapy. During this procedure,
the surgeon inserted the device and took x-rays to ensure placement. Once the
device was in the proper location, it was fixed into position by tightening the
applicator base plate and locking mechanism. Marion tolerated the procedure
well and was sent to the recovery suite in satisfactory condition. How should
today’s professional services be reported?
a. 58554, 57156 -58
b. 57156 -59, 77326-26
c. 58554, 57156 -59, 77326-26
d. 57156 -58
43. What code should be reported for a diagnostic dilation and curettage for a
patient experiencing heavy bleeding that is not associated with pregnancy?
a. 58120
b. 59160
c. 57800
d. 57700