Urinary (50000, Ch.12)
The patient presents for replacement of inflatable penile prosthesis through an infected field. What CPT® code(s) is/are reported for this service?
Selected Answer:a. 54411 Correct Answer:d. 54417 Response Feedback:Rationale: In the CPT® Index look for Prosthesis/Penis/Replacement for the code range. To report code 54411, you will need to see the word multi-component to report it. The correct code is 54417 which indicates the replacement of inflatable penile prosthesis through an infected field. Documentation does not support debridement of a necrotizing soft tissue infection eliminating 11004 as an option.
Diagnosis: Bulbar urethral strictures Procedure: Cystoscopy and dilation of urethral stricture.Medical Necessity: A very pleasant 36 year-old male with post void hematuria.Description: A 17 French cystoscope was introduced in the patient's urethra up to the level of the stricture, but I was unable to pass the urethral stricture with a Super Stiff wire, so I first passed over the Glidewire, removed the cystoscope, placed a Pollock catheter over the Glidewire, and exchanged the Glidewire for a Super Stiff wire. We then removed the Pollock catheter leaving the Super Stiff wire in place as our safety wire. I dilated the patient's urethra to 26 French without difficulty. We reintroduced the cystoscope and noted ablation of the stricture. No masses were noted within the bladder. What CPT® code(s) is/are reported for this service?
Selected Answer:a.52000, 53605 Correct Answer:d.52281 Response Feedback:Rationale: CPT® code 52281 describes a cystoscopy with calibration and/or dilation of urethral stricture or stenosis and does not limit the coder to the type of treatment, for example Goodwin sounds, filiform, dilator, etc. In the CPT® Index look for Cystourethroscopy/Dilation/Urethra. Codes 53605 and 53620 are used for the dilation of the urethra using a method other than cystourethroscopy. Code 52000 is only the cystourethroscopy and has a separate procedure designation. Codes designated as a separate procedure should not be reported in addition to the code for the total procedure or service of which it is considered an integral component.
What are the filtering units of the kidney called?
Selected Answer:b. Glomerulus Correct Answer:d. Nephrons Response Feedback:Rationale: The glomerulus and tubules are components of the nephrons, part of the kidney. Nephrons are the tiny filtering units of the kidney. The calyx is an extension of the renal pelvis that encloses the papilla of a renal pyramid that urine passes through from the papillary duct into the ureter.
Dr. Smith is treating a 72 year-old female with ureteral obstruction caused by a postoperative stricture and post radiation scarring following treatment for transitional cell cancer. The patient requires removal and replacement of an internal indwelling ureteral stent. Dr. Smith advances a diagnostic catheter under conscious sedation into the bladder and injects contrast to opacity the bladder. A guide wire is advanced into the bladder and the diagnostic catheter is exchanged for a larger catheter to allow the use of a snare device. Under the fluoroscopic guidance the snare device is negotiated into the bladder through the sheath and used to grasp the pigtail portion of the double-J ureteral stent tube within the bladder and the indwelling stent tube is pulled out of the bladder and urethra far enough to allow retrograde introduction of a guide wire through the stent, directed into the renal pelvis. Using fluoroscopic guidance to negotiate the wire through the inner lumen of the ureteral stent tube rather than through side holes, a diagnostic catheter is positioned over the wire into the renal pelvis, allowing opacification and visualization of the renal pelvis. The guide wire is repositioned into the renal pelvis and the diagnostic catheter removed. A new double-J ureteral stent tube is introduced and positioned. The guide, sheath and safety wire are removed after appropriate position is confirmed with fluoroscopy and a permanent image is obtained for the medical record.What code is used to describe the exchange?
Selected Answer:d. 50385-26 Correct Answer:c. 50385 Response Feedback:Rationale: The documented procedure is the removal and replacement of an internal dwelling ureteral stent. The catheter is introduced into the bladder indicating the transurethral approach. In the CPT® Index look for Removal/Stent/Ureteral for the code range. Code 50384 uses a percutaneous approach for only the removal of the stent and code 50386 is removal only. Code 50385 is for the removal and replacement via a transurethral approach. The code description includes the radiological supervision and interpretation and modifier 26 is not appended.
A 67 year-old gentleman with localized prostate cancer will be receiving brachytherapy treatment. Following calculation of the planned transrectal ultrasound, guidance was provided for percutaneous perineal placement of 1-125 seeds into the prostate tissue. What CPT® code is reported for needle placement to insert the radioactive seeds into the prostate?
Selected Answer:d. 55920 Correct Answer:c. 55875 Response Feedback:Rationale: Brachytherapy is a form of radiation in which radioactive seeds or pellets are implanted directly into the tissue being treated to deliver their dose of radiation in a direct fashion and longer period of time. The placement of the seeds is performed percutaneously. The code is indexed in the CPT® Index under Prostate/Insertion/Needle guiding you to code 55875.
Patient is status post left extracorporeal shock wave therapy (ESWL) performed three weeks ago; there is no global time for this procedure. He returns today for scheduled left ureteroscopy with basket extraction of ureteral calculi. What CPT® code is reported for this service?
Selected Answer:d.52352-58 Correct Answer:c.52352 Response : Many times, after an ESWL, the provider will schedule the patient for follow up extraction of the remaining stone fragments. In the CPT® Index, look for Calculus/Removal/Ureter directing you to several codes. Code 52352 is the appropriate code. Modifiers 58 and 78 are used for additional procedures performed during a global period and modifier 76 is used for a repeat of the same procedure. These modifiers aren't appropriate in this case because there is no global period.
