Tuesday, September 25, 2012

Urology Questions

Sample/Practice/Free Urology (Genitourinary) Coding Questions

1.      Please supply the appropriate ICD9 code for Calculus of ureter ___________

The following scenario is applicable to questions 2-3:

Pt is scheduled to have sonographically guided transrectal prostate biopsies,
cystoscopy with fulguration of minor lesions in the bladder, and insertion of a left

double J stent. Pre and post op DX – prostate nodule and small bladder lesions.

2. How should this scenario be coded?

a. 52224, 52332, 55700, 76942
b. 52214, 55700, 76872,
c. 55700, 52000, 76942

3. What modifier would be appended to show that a physician performed the
supervision and interpretation of the procedure? ____________

4. Cystitis is inflammation of the_____________.

a. Kidneys
b. Prostate
c. bladder

5. What is ureteral calculi?

a. stone in the kidney
b. stone in the ureter
c. stone in the urethra
d. stone in the bladder

6. Which of the following terms describes the area located at the base of the bladder?

a. Renal pelvis
b. Calyx
c. Trigone
d. Dome

7. Code the urologist’s services:

PREOPERATIVE DIAGNOSIS: Advanced carcinoma of the right ureter, morbid


DESCRIPTION OF PROCEDURE PERFORMED: Open nephrostomy with drainage catheter Patient was placed in a lateral position and after adequate general anesthesia, a right flank incision was made to gain access to the retroperitoneal space. Gerota's fascia at the lower pole of the kidney was then incised using a deep knife. The ureter was identified and isolated using Metzenbaum scissors and a small Penrose drain was used to retract the ureter. Additional blunt dissection exposed the renal pelvis where a small incision was made, Kelly forceps were used to tunnel a passageway for the nephrostomy tube. A clamp was used to pull the catheter through the tunnel until the tip was drawn into the renal pelvis. A separate flank incision was made in the skin and the end of the catheter was brought out. A large Penrose drain was placed near
the kidney and secured to the skin using silk sutures and the incision used for the
surgical approach was closed.

a. 52334
b. 50125
c. 50392
d. 50040

8. When two surgeons perform procedures described by one CPT code and both
surgeons document their part of the procedure, append a 80 modifier.

a. True
b. False

9. Removal of a kidney is called a ______________________________.

10. Code the urologist’s services:



DESCRIPTION OF PROCEDURE PERFORMED: Percutaneous nephrostolithotomy Patient was placed in a lateral position on their left side and 5 mL of lidocaine was injected for local anesthesia. Using fluoroscopy, a suitable posterior calyx of the right kidney was identified and a puncture was made below the 12th rib where a nephrostomy needle was passed into the collecting system. The needle was withdrawn and 3 mL of contrast was used to check for proper placement. Next a 0,035 guidewire (eg, 0.035 in) was passed into the collecting system and the needle was removed. A fascial incising needle was used to cut the lumbodorsal fascia and the tract was dilated by passing dilating catheters over the guidewire (6F, 8F, and 10F catheters). A 14F nephrostomy catheter was positioned over the guide wire and sutured to the skin. Next a nephroscope was passed through the tube until a single stone measuring approximately 1.5 X 1.5 cm was visualized. It was removed with some difficulty using graspers. Another 3 mL of contrast was used to confirm that no additional stones or other obstruction remained, the scope was withdrawn and the patient was returned to recovery room in good condition.

a. 50580, 5004551, 76000
b. 50580. 76000
c. 50080, 50395
d. 50081

11. Which of the following medical terms describes an abnormal opening between the bladder and vagina that permits passage of fecal material into the vagina?

a. Vesicovaginal fistula
b. Rectovaginal fistula
c. Rectocele
d. None of the above

12.      Code the urologist’s services…



PROCEDURE: Excision of phimotic foreskin

This male patient has been experiencing increasing symptoms associated with
phimosis such as pain during intercourse and difficult hygiene. After considering his options, he has elected to undergo surgical treatment. After adequate general
anesthesia, with the patient in the supine position, several Kelly hemostats were
placed at the edge of the prepuce. Next, fine dissecting scissors were used to make a longitudinal incision to the prepuce. This was extended in a circular fashion until it was possible to excise it completely and submit it for pathologic examination. Multiple small bleeders encountered were controlled using electrocautery and the skin edges were reapproximated using sutures. After adequate dressing, the patient was returned to the recovery room in good condition. The foreskin was submitted to pathology.

a. 54100
b. 54161
c. 54304, 54100
d. None of the above

13. According to the National Correct Coding Initiative, if a double Jstent is inserted at the same time as another cystourethroscopy or ureteroscopy procedure, each may be reported separately if adequately documented and medically necessary. In order to receive reimbursement for each code, a 59
modifier should be appended to the 52332.

a. True
b. False


1. 592.1
2. a
3. 26
4. c
5. b
6. c
7. d
8. False
9. Nephrectomy
10. c
11. a
12. b
13. True


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