URINARY SYSTEM

1. 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
B. 59510
C. 59514
D. 59515

2. 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
3. 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 B. 59510, 59409-51
C. 59510-22 D. 59510, 59409-51

4. 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

5. 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

6. 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
7. 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

8. 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
9. 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
10. 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

11. 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

12. 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
13. 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
14. 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
15. 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
16. 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
17. 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
18. 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 apostoperative period?
a. -22
b. -52
c. -77
d. -78
19. 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 thedelivery admission, Stephanie required prophylactic antibiotics becauseshe has
mitral valve prolapse. How should Dr. Laura report the delivery care and diagnosis for this patient?
a. 650, 424.0, V30.0, 59409
b. 424.0, 424.0, V30.0, 59510
c. 648.61, 424.0, V27.0, 59400
d. 414.0, 648.61, V27.0, 59614
20. 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
21. An established patient required medical attention for removal of an impacted foreign body from the
vaginalcanal. 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
22. 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, thesurgeon 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
23. What code should be reported for a diagnostic dilation and curettage for a patient experiencing
heavybleeding that is not associated with pregnancy?
a. 58120
b. 59160
c. 57800
d. 57700