Urinary system, male and female genital system (50000)
- A patient had a renal auto-transplantation extracorporeal surgery, re-implantation of a kidney, and a partial nephrectomy. How would you report this procedure?
- 50340, 50380, 50240-51
- 50543, 50370-52
- 50380, 50240-51
- 50380, 50240-59
- 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?
- 99222, 55876, 77763 x 51
- 55875, 77778
- 99221, 58715, 77783
- 58346, 77799 x 125
- 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?
- 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?
- 54830, 00920-51
- 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?
- 27385, 54440-59
- 27393, 54620-79
- Heather had a bilateral laparoscopic occlusion of her fallopian tubes using a Falope ring. How would you report this procedure?
- 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?
- 50605, 50382
- 50385, 52283, 99143
- Dr. Blue provided interpretation and results for a needle electromyography for anal sphincter function. How would you report this service?
- 51784, 51785-51
- 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?
- 52649, 55250-51
- 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?
- How would you report a bilateral cadaver donor nephrectomy with cold preservation?
- 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:
- 50543 B. 50547 C. 50300 D. 50320
- 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?
- 57288 B. 57287 C. 52000, 57288 D. 52000, 51992
- 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:
- 54150 B. 54160 C. 54163 D. 54164
- 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?
- 58660 B. 58740 C. 57061 D. 56441
- 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?
- 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 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|
|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.
- “c” The code 50380 reports the auto-transplantation and re-implantation of a kidney. The parenthetical note under this code directs the use of the code for nephrectomy with modifier -51.
- “b” The code 55875 represents the procedure and the code 77778 is the clinical brachytherapy. Code 77778 includes admission to the hospital and daily visits. You can find this rule in the subcategory guidelines for Clinical Brachytherapy in the CPT Professional Edition.
- “a” This is a lithotripsy, extracorporeal shock wave treatment. You can find this procedure in the index of the CPT Professional Edition under Lithotripsy.
- “d” You can find this answer in the CPT Professional Edition index under Excision, Lesion, Epididymis. Be careful with the index in this section and follow it to lesion or you may use the incorrect code.
- “a” You can find this procedure in the index of the CPT Professional Edition under Repair, Penis, Injury. You would report modifier -79 for the unrelated procedure during a post-operative period by the same physician.
- “b” The code 58671 reports this procedure via a laparoscopic approach. Modifier -50 is not necessary to report a bilateral procedure due to the code description of oviducts (which is bilateral).
- “c” The code 50385 includes the conscious sedation, radiological supervision, and interpretation. The code defines a removal and replacement so there is one code to describe the entire procedure.
- “d” The code 51785 describes this procedure. The guidelines under urodynamics indicate…“When the physician only interprets the results and/or operates the equipment, a professional component, modifier -26, should be used to identify physicians’ services.”
- “b” You can find this code in the index of the CPT Professional Edition under Prostate, Enucleation. The vasectomy procedure is bundled with code 52649.
- “d” You can find this information in the CPT Professional Edition under the Delivery After Previous Cesarean Delivery subsection.
- “d” The code 50300 describes a donor nephrectomy (including cold preservation); from a cadaver donor, unilateral or bilateral. Because the procedure is described as a unilateral or bilateral procedure, you would not report modifier -50.
- B This is a surgical laparoscopic procedure for removing the kidney (nephrectomy), eliminating multiple choice answers C and D. The whole kidney was taken out from a donor and put on ice (cold preservation), eliminating multiple choice answer A.
- A Removal or revision of the sling is not being performed, eliminating multiple choice answer B. The procedure was an open surgery, eliminating multiple choice answer D. Cystoscopy procedure code is a separate procedure. According to CPT Surgery guidelines, “The codes designated as “separated procedure” should not be reported in addition to the code for the total procedure or service of which it is considered an integral component.” Meaning that the cystoscopy is included with the sling operation procedure since it was performed at the same time.
- C The physician is not incising the membrane that attaches the foreskin to the glans and shaft of the penis (frenulum), eliminating multiple choice D. The patient is not having the circumcision for the first time, but needed a repair from a previous circumcision, eliminating multiple choice answers A and B.
- D The key term to narrow your choices down is the removal of “labial adhesions”. This is found in the code descriptive for multiple choice answer D, 56441.
- A Patient does not have a penile injury, eliminating multiple choice D. Code 54360, Plastic operation on penis to correct angulation is not correct because this patient has hypospadias and 54304 is the correct answer, thus eliminating multiple choice C. The surgery is not correcting a hypospadias complication, but straightening the curvature (chordee), eliminating multiple choice answer B. The correct answer is A, 54304. The penis was degloved and the foreskin divided into flaps to accommodate a plastic repair of the chordee. The hypospadias was not repaired at this time; however, the repair of the angulation is the first step before the hypospadias can be repaired.
- B Patient is terminating her pregnancy by dilation and evacuation (D&E), eliminating multiple choice answer A. There is no documentation of this being an incomplete abortion, eliminating multiple choice answer C. The abortion was not induced by intra-amniotic injection(s), eliminating multiple choice answer D.
- B One way to narrow down the choices is to code for the endometrial ablation using the hysteroscope. Since the endometrial ablation was done with hysteroscopic guidance, multiple choice answer A is eliminated. No biopsies were taken or polyps removed eliminating multiple choice answer C. The removal of her ovaries and fallopian tubes (oophorectomy and salpingectomy) were performed by a laparoscope, eliminating multiple choice answer D.
- D Radioactive seeds were inserted directly into the prostate transperineally using needles (percutaneous), eliminating multiple choice answers A and C. There is a parenthetical note under code 55875 that states “For interstitial radioelement application, see 77776-77787“. A urologist may insert the hollow needles into the prostate (55875) and the physicist may insert the seeds into the needles. Some insurance companies permit one physician to report both the insertion of the needles and the seeds.
- D Patient had started with a laparoscopic treatment for a tubal ectopic pregnancy. Due to the patient’s body size the laparoscopic approach was terminated, eliminating multiple choice answers A and B. The patient had the left fallopian tube removed (salpingectomy) removed, eliminating multiple choice answer C. When an laparoscopic surgical procedure fails, only the successful open procedure is reported (NCC Manual, version 6.1, April-June, 2000). Modifier -22 for unusual procedure would only be appended if the situation was truly unusual; therefore, it is not appropriate for this case
- C There is no documentation that supports the patient had a previous cesarean, eliminating multiple choice answer A. There is no documentation that supports patient having antepartum care or will be having postpartum care with the obstetrician delivering the baby, eliminating multiple choice answers B and D.
- C Patient is having a repair for a rectocele, not a cystocele, eliminating multiple choice answers B and D. The repair of rectocele was performed by a “posterior” colporrhaphy approach, eliminating multiple choice answer A.
- B. According to CPT® guidelines, when twins are delivered, the global code (prenatal, delivery and post partum) is only reported once. When one twin is delivered via c-section select 59510 for the global procedure and the vaginal delivery only (54909) for the second twin. Modifier 51 is appended to indicate multiple procedures are performed. To code for the twin delivery in the ICD-9-CM manual, look up Delivery/twins, you are referred to 651.0X, the fifth digit being 1 indicating a delivery. The second diagnosis is coded due to the second twin being in a transverse lie, the reason for the cesarean. This is indexed under Delivery/ complicated / transverse/presentation or lie, referring to 652.3X, the fifth digit being a 1.
24.B. The removal of cyst from the ovary is coded 58925. The RT modifier is appended to indicate to the payer the ovarian cystectomy was performed on the right side. The removal of the salpingo-oophorectomy is coded 58720. Modifiers 51 and LT are appended to this procedure code since the removal of the ovary and fallopian tube was done on the left side and it was an additional procedure performed during the surgery.
- A. Since this a 35-year-old patient getting a circumcision, that eliminates code 54160, which is for a neonate (28 days of age or less). The patient is having the circumcision performed using a clamp with regional block. Modifier 52 is not appended to 54150 since there is no indication in the encounter of the physician reducing the services provided. The procedure is performed as it is described by the CPT® code.
- C. 55700 is the correct code since only needle biopsies were performed, without mapping the prostate under a template guide through a transperineal route. There are parenthetical notes under code 55700, which one states: (If imaging guidance is performed, use 76942). Since ultrasonic guidance (imaging guidance) was used, you would need to code 76942. Appending modifier 26 indicates the professional component; the procedure was done in an outpatient surgical center where the physician does not own equipment.
- B. One way to get to the correct answer is to code for the diagnosis first. The procedure is being performed due to the patient having vaginal lesions. In the ICD-9-CM index, look up Lesion(s)/vagina. You eliminate multiple choice answers C and D. 57065 is the correct code since the scenario states that the laser surgery was used to destroy “extensive” number of vaginal lesions.
- B. The physician performs a cervical cerclage. We know the patient is pregnant so 57700 is an incorrect code. We know the approach for this procedure is vaginally because the scenario states that a speculum is used to access the vagina to view the cervix. From the index look up cerclage/vaginal. You are referred to 59320. The patient is diagnosed with an incompetent cervix. In the ICD-9-CM index, look up incompetent/cervix/in pregnancy. The patient is pregnant so the fifth digit is “3”.
- C. 52000 is a separate procedure, which indicates that only a cystourethroscopy is performed for diagnostic (examination) purposes only with no other procedure being performed at this time. For this scenario a surgical procedure was performed with the cystourethroscopy, eliminating multiple choice answers A and B. 52204 is not coded because biopsies were not taken from the bladder, leaving multiple choice answer C as the correct choice since a 7 cm bladder tumor was removed with fulguration.
- D. The hint to narrow down your choices is a D&C (dilation and curettage) for a blighted ovum. This eliminates multiple choice answers A (there is no indication this was a hydatidiform molar pregnancy) and B (there is no indication that this is a missed abortion). 58120 is not the correct D&C, since this is an obstetrical (pregnancy) reason for the procedure. Blight ovum is indexed in the ICD-9-CM under Mole/pregnancy.
- A. This patient is having a stent removed, eliminating multiple choice answers B and D, which should be used for insertion of a stent. You would not code 52000 since this is a separate procedure, which means that this code is only billed for diagnostic or examination purposes only, with no other procedures being performed at that time. A surgical procedure (removal of the stent) was done at the same time of the cystoscopy. Code 74420 is coded for the use of a retrograde ureterogram (urography). Modifier 26 is appended to report the professional component was performed.
- D. You can narrow down your choices by first coding the diagnosis. The patient had testicular cancer; in the ICD-9-CM index go to the Neoplasm Table testis,testes/malignant/primary column where you are referred to code 186.9. This eliminates codes A, B, and C. 54690 is the correct procedure code since a laparoscopy was performed to remove the left testicle (orchiectomy).
- c. One way to find this answer in the index of the CPT® Professional Edition is under the main term “Prostate,” then “Biopsy.” Notice that code 55700 indicates single or multiple, which means the code should be reported only one time per session.
- b. Code 54000 describes a newborn; therefore, modifier -63 would not be reported with this code. The CPT® Professional Edition provides this information in the parenthetical note following this code.
- d. Code 54065 includes extensive destruction of lesion(s) of the penis. This code is reported one time regardless of the number of lesions destroyed during a session.
- a. Review of the subcategory notes in the CPT® Professional Edition with urodynamics indicates that modifier -51 should be used when more than one of these codes is listed in the same investiture session.
- b. Code 52282 indicates stent (singular); therefore, when more than one stent is placed, the units should be reported.
- d. The parenthetical notes provided in the CPT® Professional Edition with procedure code for resection of residual prostate tissue indicate modifier -78 would be appended if the procedure is performed by the same physician during a postoperative period.
- c. The routine obstetric care, including the ante- and postpartum care with vaginal delivery, is reported with code 59400. The diagnosis codes for this case are assigned for the pregnancy complicated by cardiovascular disease. The mitral valve prolapse is then reported as the specific condition. According to the ICD-9 Guidelines for Chapter 11, these codes have sequencing priority.
- a. One way to find this answer in the index of the CPT® Professional Edition is under the main heading “Miscarriage,” then “Incomplete Abortion.”
- b. The CPT® Professional Edition provides a parenthetical note below code 57415 that references use of evaluation and management codes for impacted vaginal foreign body removal without anesthesia. This is an example of reading carefully to select the correct answer. The question does not ask for the evaluation and management code, only the procedure; therefore, answer A is not correct.
- d. According to CPT® Changes: An Insider’s View 2011, this new code includes x-ray confirmation forlocation of the apparatus.
- a. Code 58120 is described as non-obstetrical, whereas 59160 is used for postpartum hemorrhage.