Chapter 12: Urinary System and Male Genital System

A Urologist examines the urinary collecting system with a cystourethroscope and removes four bladder tumors by fulguration. Two tumors measured 1.5 cm and the other two tumors measured 2.5 cm and 3.0 cm. What code(s) should be reported? A.52234 x 2, 52235 x 2 B.52240 C.52234 D.52235

Answer: D. 52235 Rationale: Look in the CPT® Index for Fulguration/Cystourethroscopy with/Tumor. You are referred to 52234, 52235, 52240, and 52250. When different size bladder tumors are removed in one surgical session, the code selection is based on the largest tumor size. In this example, the largest tumor removed is 3.0 cm. Only one code is reported regardless of the number of tumors removed.

Key Roots, Suffixes, and Prefixes for the Genitourinary System

-cele - herniation, or prolapse cyst/o - filled sac or pouch, cyst, bladder, urinary bladder dys- abnormal, painful, difficult -ectomy - excision, surgical removal ex/o - away from, outside hydr/o - water, fluid -ia/sis - condition of -itis - inflammation lith - calculus, stone -lysis - separation, loosening, dissolving, destruction nephr/o - kidney -oma - tumor orchi/o - testis -orrhaphy - surgical repair/suture osche/o - scrotum -oscopy - to examine through a scope -ostomy indicates a surgically created artificial opening -otomy - cutting into (incision) -pexy - surgical fixation or suspension pyel/o - renal pelvis vesic/o - urinary bladder

A circumcision was performed on a newborn using a dorsal penile nerve block for anesthesia. The provider used a Plastibell for this circumcision. What CPT® code is reported? A.54150 B.54160 C.54161 D.54150-52

Answer: A. 54150 Rationale: In the CPT® Index, look for Circumcision/Surgical Excision/Neonate 54150, 54160. A Plastibell is a type of device used in a circumcision. Code 54150 is correct. Modifier 52 is not required; because a dorsal penile nerve block was used. Code 54160 is specific to a surgical circumcision performed with "other than clamp or device" making this code incorrect. Code 54161 describes circumcision for a patient over the age of 28 days making this an incorrect code as well.

Using the scenario above, code the return to the operating room for vasectomy on the left side during the postoperative period. A.55250-58 B.55250-78 C.55250-76 D.55250-LT

Answer: A. 55250-58 Rationale: Using modifier 76 on the left vasectomy is not appropriate because modifier 76 denotes a return to the operating room for a repeat procedure by the same physician during the global period. This is not a repeat procedure on the right side. Modifier 58 is appropriate because the vasectomy is a follow up to the initial vasectomy (staged or related procedure). Look in the CPT® Index for Vasectomy and refer to Appendix A for modifier 58.

To report a repeat procedure by the same physician, what modifier is reported? A.76 B.78 C.58 D.79

Answer: A. 76 Rationale: Sometimes it is necessary for a physician to repeat a procedure. When this occurs, modifier 76 is appended.

A 65-year-old woman diagnosed with a right renal tumor is status post hand-assisted laparoscopic nephrectomy. Pathology report reveals a definitive diagnosis of renal oncocytoma. What is the ICD-10-CM code? A. D30.01 B. C64.9 C. C65.1 D. D30.11

Answer: A. D30.01 Rationale: Look in the ICD-10-CM Alphabetic Index for Oncocytoma, which directs you to see Neoplasm, by site, benign. Look in the Table of Neoplasms for Neoplasm, neoplastic/renal/Benign column D30.0-. In the Tabular List report 5th character 1 for right kidney. Correct code choice is D30.01.

Where is urine formed? A.Kidneys B.Renal Pelvis C.Bladder D.Ureters

Answer: A. Kidneys Rationale: Urine is formed in the renal tubules and empties into the calyces, then into the renal pelvis of the kidney. It then travels through the ureters to the bladder.

The patient is a 68-year-old male with urinary retention and enlarged prostate gland. He has failed conservative treatment and presents for TURP. What is/are the ICD-10-CM code(s)? A. N40.1, R33.8 B. R33.8, N40.1 C. N40.0 D. N41.9

Answer: A. N40.1, R33.8 Rationale: In the ICD-10-CM Alphabetic Index look for Enlargement, enlarged/prostate/with lower urinary symptoms (LUTS) and you are directed to N40.1. In the Tabular List there is an instructional note to Use additional code for associated symptoms, when specified. Urinary retention is coded with R33.8.

Which gland in the male reproductive system is partly muscular and partly glandular? A.Prostate B.Seminal Vesicle C.Bladder Neck D.Testes

Answer: A. Prostate Rationale: The prostate gland is the gland that is partly muscular and glandular

What modifier is appended to report a bilateral procedure? A.51 B.50 C.RT and LT D.B or C

Answer: A. TC Rationale: Some CPT® codes have a technical component and a professional component. Modifier 26 is appended when the professional component is provided, and modifier TC is appended when the technical component is provided. Professional services are those in which the physician performs supervision and interpretation with report. Technical services include ownership of the equipment, space, and employment of the technicians or nurses who performed the study.

What modifier is appended to report the technical component of a procedure? A.TC B.26 C.TC and 26 D.None of the above

Answer: A. TC Rationale: Some CPT® codes have a technical component and a professional component. Modifier 26 is appended when the professional component is provided, and modifier TC is appended when the technical component is provided. Professional services are those in which the physician performs supervision and interpretation with report. Technical services include ownership of the equipment, space, and employment of the technicians or nurses who performed the study.

Patient presents for insertion of a draining tube due to a neurogenic bladder. The physician performs the procedure by making a small skin incision into the lower abdominal wall, then an open incision in the bladder for placement of the catheter for drainage. What CPT® code is reported? A.51102 B.51040 C.51045 D.51705

Answer: B. 51040 Rationale: Aspiration of bladder with insertion of suprapubic catheter (51102) does not describe an open suprapubic tube insertion. Suprapubic catheter change is reported using CPT® 51705; therefore, this code is not reported for an insertion procedure. Because 51045 describes a ureteral catheter or stent, this code is not appropriate. CPT® 51040 Cystostomy, cystotomy with drainage describes the open suprapubic tube placement via an incision (-otomy) into the bladder. Look in the CPT® Index for Cystostomy/with Drainage 51040. Verify in the numeric section.

When all the components in code 54405 are not performed, what modifier is reported? A.50 B.52 C.53 D.58

Answer: B. 52 Rationale: Modifier 52 is used to report reduced services. There is a parenthetical under code 54405 that indicates for reduced services, report 54405 with modifier 52.

The urologist is asked by the general surgeon to place ureteral catheters for visualization of ureters during a complicated bowel surgery. Cystoscopy is performed, and ureteral catheters are inserted. The general surgeon removes the catheters at the end of the case. What CPT® code is reported? A.52332 B.52005 C.52310 D.50605

Answer: B. 52005 Rationale: Placement of the ureteral catheters was performed via cystoscopy; CPT® 50605 would not be appropriate because this code is for an open insertion of indwelling stent into the ureter. CPT® 52332 describes the insertion of an indwelling ureteral stent and is not reported for temporary catheter insertion. CPT® 52310 describes the removal of a ureteral stent but does not cover the insertion of the catheters. CPT® 52005 Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation or ureteropyelography, exclusive of radiologic services is correct. There would be no additional code reported for removal of these catheters. Look in the CPT® Index for Catheterization/Cystourethroscopy/ Ureteral. No modifier is used because this code includes both ureters.

The patient presents with recurrent bladder outlet obstruction secondary to prostate enlargement and requires transurethral resection of the prostate (TURP). The patient previously had a TURP 10 years ago. What code is reported for the TURP? A.52601 B.52630 C.52648 D.52500

Answer: B. 52630 Rationale: As a previous TURP was performed, CPT® 52601 is not appropriate because this code is used for the initial TURP. CPT® 52648 describes laser vaporization of the prostate, which is not the case. CPT® 52500 is described as transurethral resection of bladder neck. Because the prostate was resected, not the bladder neck, this is inappropriate. CPT® 52630 describes TURP of residual or regrowth of obstructive prostate tissue, which is the appropriate code. Look in the CPT® Index for TURP—See Prostatectomy, Transuretheral 52601, 52630. Verify in the numeric section.

When a procedure is terminated due to circumstances that threaten the well-being of the patient, which modifier is appended to the procedure code? A.52 B.53 C.54 D.26

Answer: B. 53 Rationale: When a procedure is terminated to preserve the well-being of the patient, modifier 53 is appended to the procedure code.

A 60-year-old man with prostate cancer is status post-radical prostatectomy. Prostate specific antigen (PSA) test detects high-grade disease. He is here to discuss gold fiducial marker seed placement for adjuvant radiation therapy. What is the ICD-10-CM code? A. Z85.46 B. C61 C. D40.0 D. D49.59

Answer: B. C61 Rationale: Because this patient still has documented disease, Z85.46 Personal history of malignant neoplasm of prostate is incorrect. Neoplasm of unspecified behavior of other genitourinary organs, D49.59 not coded because prostate cancer is documented. Uncertain behavior of prostate neoplasm, as well as uncertain behavior of other neoplasms, should be coded only when the pathological report states uncertain. Look in the ICD-10-CM Alphabetic Index for Cancer and you are directed to see also Neoplasm, by site, malignant. In the Table of Neoplasms look for Neoplasm, neoplastic/prostate/ Primary column C61. Verify code selection in the Tabular List.

A right side epididymectomy and spermatocelectomy are performed on a 15-year-old male. What CPT® code is reported? A.54860 B.54861 C.54840 D.54830

Answer: C. 54840 Rationale: Code 54840 describes the excision of spermatocele, with or without epididymectomy and is the correct code. The epididymectomy codes (58460-58461) are not reported as the procedure is included in 54840. A lesion was not removed from the epididymis, making 54830 incorrect. Look in the CPT® Index for Spermatocele/Excision 54840

Patient presents for bilateral vasectomy. The vas deferens could not be located on the left side and a unilateral vasectomy is performed. The patient will be scheduled for left vasectomy under general anesthesia next week. How is the initial vasectomy reported? A.55250-53 B.55250-RT C.55250 D.55250-52

Answer: C. 55250 Rationale: CPT® 55250 is the correct code to report. No modifiers are reported with the vasectomy code because the descriptor states unilateral or bilateral. The procedure was not terminated due to the well-being of the patient (modifier 53), nor would you report a decreased service (modifier 52). Because of the code description, modifier RT is not necessary. Look in the CPT® Index for Vasectomy 55250.

Mrs. Green is a 53-year-old woman with bilateral nephrolithiasis. What is/are the ICD-10-CM code(s)? A.N20.1 B.N21.1 C.N20.0 D.E83.59, N29

Answer: C. N20.0 Rationale: Documentation of calculus of the kidney and ureter are very specific to the organ site involved. Though most stones are calcium based, coding a disorder of calcium metabolism would be incorrect. Calculus of the urethra and ureter are not correct because the documentation indicates nephrolithiasis (kidney stone). Kidney stone, or nephrolithiasis, is coded N20.0. In the ICD-10-CM Alphabetic Index, look for Calculus, calculi, calculous/kidney directing you to N20.0. Verify code selection in the Tabular List.

Mr. Jones is an 85-year-old male who has gross hematuria, likely from a prostatic source. He has had a TURP in the past. What is the ICD-10-CM code for gross hematuria? A.N40.0 B.R31.9 C.R31.0 D.R31.29

Answer: C. R31.0 Rationale: Although there is documentation that the patient previously had a TURP, there is no documentation of continuing BPH (a condition for which a TURP routinely is performed). Because documentation states gross hematuria, microscopic or unspecified hematuria would be inappropriate codes. Gross hematuria R31.0 is the correct answer. In the ICD-10-CM Alphabetic Index, look for Hematuria/gross directing you to R31.0. Verify code selection in the Tabular List.

Jake is a 16-year-old male involved in an MVA this morning. He was the only occupant in the vehicle. No other details are available. CT examination shows the patient has a minor fractured (lacerated) right kidney. What is the ICD-10-CM code for the fractured kidney? A.S37.001A B.S37.091A C.S37.041A D.S37.011A

Answer: C. S37.041A Rationale: A fractured kidney is a laceration connecting to two cortical surfaces. Look in the ICD-10-CM Alphabetic Index for Laceration/kidney/minor directing you to S37.04-. In the Tabular List, seven characters are required to complete the code. The 6th character 1 is for right kidney and the 7th character of A is for initial encounter. Complete code is S37.041A. Verify code selection in the Tabular List. A diagnosis code for the external cause also would be added for the MVA.

Which organ is not considered part of the urinary system? A.Kidney B.Bladder C.Spleen D.Urethra

Answer: C. Spleen Rationale: The organs making up the urinary system consist of the kidneys, ureters, bladder, and urethra. The spleen is part of the body's lymphatic system.

Urine is expelled from the body through the: A.Ureters B.Bladder C.Urethra D.Seminal Vesicle

Answer: C. Urethra. Rationale: The urine travels from the kidneys to the ureters, to the bladder, where it is stored until it is expelled through the urethra.

Excision of urachal cyst and an incarcerated umbilical hernia repair were performed on a six-year-old male. What CPT® code is reported? A.49580 B.49587 C.49585 D.51500

Answer: D. 51500 Rationale: Umbilical hernia repair codes are reported 49580-49587 and are differentiated by the age of the patient and whether the hernia is reducible, or incarcerated/strangulated. A reducible hernia is one that can be reduced to a normal position. An incarcerated or strangulated hernia is one that cannot be reduced to a normal position without surgical intervention. The description of CPT® 51500 Excision of urachal cyst or sinus, with or without umbilical hernia repair includes the umbilical hernia repair. Hernia repair is not reported separately; therefore, CPT® 51500 is the correct answer. Look in the CPT® Index for Cyst/Urachal/Bladder/Excision 51500.

Patient presents for treatment of multiple condyloma on the penis. The excised diameter is 0.8 cm. What CPT® code is reported? A.11420 B.11421 C.11621 D.54060

Answer: D. 54060 Rationale: Surgical excision of condyloma(s) of the penis is reported using CPT® 54060. Report this procedure only once because the description includes multiple condyloma excision during a single/same surgical setting. CPT® 11420 describes excision of a benign lesion of the genitalia but is not specific to condyloma and the diameter of the lesion excision is stated as 0.5 cm or less. CPT® 11421 describes a benign lesion excised from the genitalia 0.6 cm to 1.0 cm and would be appropriate had there not been a clear and concise code for condyloma excision. CPT® 11621 describes a malignant lesion excision and is not reported because there is no documentation of a malignant lesion excision. Tip: When determining the specific code to report, the body system or organ should be accessed first, before using the integumentary codes. Look in the CPT® Index for Condyloma/Penis for the range of codes.

Mr. Brown presents today with a sudden onset of chills and fever with dull pain in the flank over the kidneys, which are tender when palpated. He has urgency and frequency of urination. Diagnosis is acute pyelonephritis. What is the ICD-10-CM code? A. N12 B. N11.0 C. N11.8 D. N10

Answer: D. N10 Rationale: Acute pyelonephritis is coded N10, unless mention of a lesion of renal medullary necrosis is documented. Do not use chronic pyelonephritis because the documentation clearly states "acute." Look in the ICD-10-CM Alphabetic Index for Pylonephritis/acute N10. Verify code selection in the Tabular List.

Mr. James is an established patient with calculus in diverticulum of bladder. What is the ICD-10-CM code? A. K57.90 B. N21.8 C. N32.3 D. N21.0

Answer: D. N21.0 Rationale: Looking in the ICD-10-CM Alphabetic Index in this example is critical in selecting the correct code. If you look for the main term Bladder in the Alphabetic Index it indicates to see condition. If you look for the main term Diverticulum, diverticula/bladder it directs you to code N32.3 which is diverticulum of bladder. There is a stone in the diverticulum of bladder. If you look for Calculus, calculi, calculous/bladder (diverticulum) it directs you to the code N21.0 which is the correct code. Verify code selection in the Tabular List.

A 13-year-old male presents with complaints of urinary hesitancy, frequency, and dysuria. A microscopic urinalysis confirmed the presence of white blood cells (WBC), and a diagnosis of UTI is confirmed. What is the ICD-10-CM code? A. R35.0 B. R39.11 C. R30.0 D. N39.0

Answer: D. N39.0 Rationale: Urinary hesitancy (R39.11), urinary frequency (R35.0) and dysuria (R30.0) are all symptoms of a urinary tract infection. Because a diagnosis of UTI was confirmed by microscopic analysis, the symptoms would not be coded. Look in the ICD-10-CM Alphabetic Index for Infection, infected, infective/urinary (tract) N39.0. Verify code selection in the Tabular List.

Mr. Black is a 53-year-old male who presents today for follow up of his stress incontinence. He has been using timed voiding and Kegel exercises, but his symptoms continue. What ICD-10-CM code is reported? A.N39.41 B.R32 C.N39.46 D.N39.3

Answer: D. N39.3 Rationale: Unspecified urinary incontinence is coded as R32; because documentation clearly states stress incontinence, this code would be inappropriate. Mixed urinary incontinence is a combination of urge and stress incontinence; because there is no mention of urge incontinence, codes N39.41 and N39.46 would be incorrect. Look in the ICD-10-CM Alphabetic Index for Incontinence/urine/stress (female) (male) directing you to N39.3. Verify code selection in the Tabular List.

What are the reproductive glands located in the scrotum? A.Urethra B.Vas Deferens C.Seminal Vesicles D.Testes

Answer: D. Testes Rationale: The testes are the reproductive glands, the seminal vesicles contribute fluid to the ejaculatory duct, and the vas deferens transports the sperm, where it exits through the urethra.