50000 Series Question Urinary System

Q.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

Q.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

Q.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

Q.4 Tom was placed under general anaesthesia (by an anaesthesiologist) 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
Q.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

Q.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

Q.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

Q.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
Q.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

Q.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

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

Q.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

Q.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
Q.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
Q.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

Q.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

Q.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

Q.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

Q.20. 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

Q.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, 21, Z37.0
(b) 59510, O64.1XX0, Z37.0
(c) 59514, O82, Z37.0
(d) 59515, O82, Z37.0

Q.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

Q.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, O30.001, O32.2XX0
(b) 59510, 59409-51, O30.001, O32.2XX0
(c) 59510-22, O30.001, O30.001, O32.2XX0
(d) 59510, 59409-51, O30.001, O64.0XX0

Q.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
salpingooophorectomy. Code this encounter.
(a) 58720-RT, 58925-LT
(b) 58925-RT, 58720-51-LT
(c) 58925, 58720-50
(d) 58720, 58925-51

Q.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

Q.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

Q.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, N89.8
(b) 57065, N89.8
(c) 57000, N85.9
(d) 57120, N85.9

Q.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, T79.9XXS
(b) 59320, O09.529
(c) 59325, N88.3
(d) 59899, N88.3

Q.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

Q.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, M96.631
(b) 59820, M96.631
(c) 58120, M96.631
(d) 59840, M96.631

Q.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

Q.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, C62.00
(b) 58671, E29.8
(c) 54640, E29.8
(d) 54690, C62.00

Q.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

Q.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

Q.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.
(a) 54057 x 12, 54065-59
(b) 54065 x 12
(c) 54057-22
(d) 54065

Q.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

Q.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
Q.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
Q.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) O80, I34.0, Z38.00, 59400
(b) I34.0 , Z38.00, 59510
(c) O99.411, I34.0, Z37.0, 59400
(d) I25.10 , O99.411, Z37.0, 59614

Q.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

Q.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
Q.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, 77770-26
(c) 58554, 57156 -59, 77236-26
(d) 57156 -58

Q.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

ANSWERS :–
1-C , 2-B , 3-A , 4- D, 5-A , 6-B , 7-C, 8-D, 9-B, 10-D ,
11-D , 12-B , 13-A , 14-C , 15- D, 16-A , 17-B , 18- B, 19-D , 20-D ,
21-C , 22-C, 23-B , 24-B , 25-A , 26-C , 27-B, 28-B, 29- C, 30- D,
31-A , 32- D, 33-C , 34-B , 35- D, 36-A , 37-B , 38- D, 39-A , 40- A , 41-A, 42-D,
43-A.