Question 1

A patient has a choledochal cyst that needs to be removed. What CPT code should be used for the removal of this type of cyst?

Accepted Answer

47715 is the correct code for excision of a choledochal cyst.
Code 47630 is incorrect because this code is used for biliary duct stone extraction. Code 47711 is incorrect because it is the code for the excision of a bile duct tumor. Code 47999 is incorrect because the removal of choledochal cyst has a specific code, so it would not fall under the code for unlisted procedure of the biliary tract.

Question 2

A patient needs to have a percutaneous biliary endoscopy with removal of calculi. What CPT code should be used for this procedure?

Accepted Answer

47554 is correct because this is the code for percutaneous biliary endoscopy with removal of calculus/calculi.
Code 47552 is incorrect because this is the code for percutaneous biliary endoscopy with collection of specimens by brushing and/or washing. Code 47553 is incorrect because this is a percutaneous biliary endoscopy with single or multiple biopsies. Code 47555 is incorrect because this is percutaneous biliary endoscopy with dilation of biliary duct stricture without stent placement.

Question 3

A patient with pancreatic cancer needs to have peripancreatic drains placed for acute pancreatitis. What CPT code should be used for this procedure?

Accepted Answer

48000 is the correct code for peripancreatic drain placement for pancreatitis.
Code 48001 is incorrect because there was no mention of cholecystostomy, gastrostomy or jejunostomy. Code 48020 is incorrect because there was no removal of pancreatic calculus. Code 48510 is incorrect because there was external drainage of pancreatic pseudocyst.

Question 4

A 56-year-old patient has a pancreatic adenoma. She is scheduled for surgery to have this removed. What is the proper CPT code for excision of this type of lesion?

Accepted Answer

48120 is the correct code for excision of lesions of the pancreas, including cysts or adenomas.
Code 48102 is incorrect because this is the code for a percutaneous needle biopsy of the pancreas. Code 48148 is incorrect because this code is for the excision of the ampulla of Vater. Code 48155 is incorrect because this is the code for a total pancreatectomy.

Question 5

A 28-year-old male noticed a painful bulging around his belly button that worsened during and after working out. He was seen by a general surgeon who recommended laparoscopic surgery for a reducible umbilical hernia with mesh insertion. What CPT code should be used for this procedure?

Accepted Answer

49652 is the correct code for laparoscopic umbilical hernia repair with mesh insertion for a reducible hernia.
Code 49650 is incorrect because this surgery is for an inguinal hernia. Code 49653 is incorrect because this is a laparoscopic umbilical hernia repair that is incarcerated or strangulated. Code 49654 is incorrect because this is for a laparoscopic repair of an incisional hernia with mesh insertion.

Question 6

A 9-month-old baby has an incarcerated right inguinal hernia with hydrocele that needs to be repaired. What CPT code should be used for this procedure?

Accepted Answer

49501 is the correct code for an incarcerated inguinal hernia for ages six months to younger than five years of age.
Codes 49492, 49496 and 49507 are all the codes for incarcerated inguinal hernia repair. However, these codes are different due to the ages of the patients the procedures are performed on. Code 49492 is for preterm infants (younger than 37 weeks at birth) performed from birth up to 50 weeks postconception age. Code 49496 is the code for full-term infants younger than six months or preterm infants older than 50 weeks postconception age and younger than six months. Code 49507 is the code for ages five years of age or older.

Question 7

An abdominal paracentesis is performed for a patient who has ascites to obtain a sampling of the fluid for testing and to provide relief for the patient's discomfort. No imaging guidance was necessary for this procedure. What CPT code should be used for this procedure?

Accepted Answer

49082 is the correct code for abdominal paracentesis (diagnostic or therapeutic) without imaging guidance.
Code 49060 is incorrect because this is the code for open drainage of a retroperitoneal abscess. Code 49083 is incorrect because this code is for an abdominal paracentesis with imaging guidance. Code 49084 is incorrect because this code is for peritoneal lavage including imaging guidance when needed.

Question 8

A physician endoscopically removed a 0.3 cm calculus from patient's right kidney under general anesthesia. Access was gained through an established nephrostomy. What is the correct code for this procedure?

Accepted Answer

The correct code for this procedure is 50561(Renal Endoscopy through Established Nephrostomy or Pyelostomy, with or without Irrigation, Instillation, or Ureteropyelography, Exclusive of Radiologic Service; with Removal or Foreign Body or Calculus). Codes 50060 and 50075 are incorrect because they are used for the removal of the calculus via an open incision, or nephrolithotomy. Code 50580 is incorrect because it is used for an endoscopic removal of a calculus through a nephrotomy; while in this case, access for the procedure was gained through a nephrostomy.

Question 9

A 25-year-old female patient with ESRD received a dual renal transplant without nephrectomy. What is the correct code for this transplant?

Accepted Answer

The correct code for this transplant is 50360 (Renal Allotransplantation, Implantation of Graft; without Recipient Nephrectomy) and modifier -50. Modifier -50 must be included on the claim to indicate that the service was bilateral (it was performed dually). Code 50365 is incorrect because it is used for a renal transplantation with nephrectomy, meaning that the patient's kidneys were removed before the transplants were implanted. This was not the case.

Question 10

A physician performed a cystoscopy with ureteral stent removal. What is the appropriate CPT code?

Accepted Answer

The appropriate CPT code is 52310 (Cystourethroscopy, with Removal of Foreign Body, Calculus, or Ureteral Stent From Urethra or Bladder; Simple). Code 52000, for cystourethroscopy should not be reported separately as the term "separate procedure" is within the code description. In other words, you do not need to report it unless it was the only procedure performed. In this case, it is included within the code for the primary procedure, 52310. Code 52315 is also incorrect because there is no mention of the procedure being complicated.

Question 11

The patient presents to the gynecologist's office complaining of stress incontinence. The GYN decides to perform a sling operation using synthetic materials to reinforce the patient's muscles and allow for additional urinary control. This procedure is performed laparoscopically in order to be less invasive. What is the correct code for this procedure?

Accepted Answer

Code 51992 (Laparoscopy, Surgical; Sling Operation for Stress Incontinence) is the appropriate code for this procedure. Codes 57288 and 57287 are used for open procedures and although code 51990 is also used for laparoscopic stress incontinence, this code refers to urethral suspension not a sling.

Question 12

A 38-year-old female patient with severe endometriosis and urethral malignancy received pelvic exenteration with removal of bladder and ureteral transplantations. The patient also received a full hysterectomy. What is the correct code for this service?

Accepted Answer

The correct code for this service is 51597 (Pelvic Exenteration, Complete, for Vesical, Prostatic, or Urethral Malignancy, with Removal of Bladder and Ureteral Transplantations, with or without Hysterectomy and/or Abdominoperineal Resection of Rectum and Colon and Colostomy, or any Combination Thereof). Code 58285, for radical hysterectomy, should not be reported separately, as code 51597 already includes hysterectomy. Code 58240 is incorrect because it is used for a pelvic exenteration performed due to a gynecologic malignancy. In this case, the patient had a urethral malignancy, not gynecologic malignancy.

Question 13

An 87-year-old male patient in a rehab hospital status-post hip transplant is having trouble voiding. After his last voiding, the physician measured his bladder capacity using a non-imaging ultrasound device. How should you code for this procedure?

Accepted Answer

You should code for this procedure with 51798 (Measurement of Post-Voiding Residual Urine and/or Bladder Capacity by Ultrasound, Non-Imaging). Modifier -50 should not be used for a bilateral procedure. In this case, the procedure cannot be done bilaterally.

Question 14

A physician performed an endoscopic resection of a 2.3 cm bladder tumor. What is the correct CPT code?

Accepted Answer

The correct CPT code is 52235 (Cystourethroscopy, with Fulguration and/or Resection of; MEDIUM Bladder Tumor(s) (2.0 to 5.0 cm)). The procedure description states that the bladder tumor was 2.3 cm, so it fits within the medium size category for bladder tumors. Code 52234 is used for small (0.5 up to 2.0 cm) tumors and code 52240 is used for large (over 5.0 cm) tumors.

Question 15

PROGRESS NOTE PATIENT: Davis, Levi
DATE: 09/08/2014
MEDICAL NOTE:
The patient is actively being treated for bladder cancer. The patient presented to the office today for bladder instillation treatment. The patient was catheterized and his bladder was emptied of all contents. An anticarcinogenic agent was introduced into the bladder at 0100 hours. The patient was instructed to lie in supine position for 45 minutes. The physician returned at 0145 hours and emptied the bladder of the anticarcinogenic agent. The patient tolerated the procedure well. The patient was instructed to return to office in one week for the next treatment and a follow-up examination. What is the correct code for the instillation treatment only?

Accepted Answer

The correct code for the instillation procedure is 51720 (Bladder Instillation of Anticarcinogenic Agent (Including Retention Time)). In this procedure, an anticarcinogenic agent for the treatment of cancer was instilled into the bladder and held for a certain amount of time in order to kill cancer cells. This is a common treatment for bladder cancer.

Question 16

A physician performed an incision and drainage on a complicated deep penile abscess. What is the appropriate code for this procedure?

Accepted Answer

The appropriate code for this procedure is 54015 (Incision and Drainage of Penis, Deep). Codes 10061 and 10081 are incorrect because they are integumentary codes that refer to the incision and drainage of deep abscesses of the skin. In this case, the abscess is not in the skin of the penis, it is in the deep tissue of the penis, therefore integumentary codes are inappropriate.

Question 17

A pediatrician performed a routine circumcision on a newborn baby boy in a hospital setting. The physician anesthetized the area with dorsal penile block, clamped the foreskin away from the tip of the penis and excised the excess foreskin. What is the correct code for the circumcision?

Accepted Answer

The correct code for the circumcision is 54150 (Circumcision, Using Clamp or Other Device with Regional Dorsal penile or Ring Block). Code 54160 is not correct because it is used for a circumcision without using a clamp or other device. You should not use modifier -47 (Anesthesia by Physician) because the anesthesia was included in the procedure description. Modifier -47 guidelines state that the modifier is not to be used with local anesthesia and a penile ring block is a local anesthetic.

Question 18

A physician performed an orchiopexy via an inguinal approach for intra-abdominal testis. What is the correct code for this procedure?

Accepted Answer

The correct code for this procedure is with code 54640 (Orchiopexy, Inguinal Approach, with or without Hernia Repair). Codes 54690 and 54692 are orchiopexy and orchiectomy codes, but are not appropriate because the procedure was not performed laparoscopically. Code 54650 is also incorrect because it is used for an orchiopexy performed via an abdominal approach not an inguinal approach.

Question 19

A physician performed a bilateral excision of the vas deferens for the purpose of sterilization on a 45-year-male. What is the correct code for this procedure?

Accepted Answer

The correct code for this procedure is 55250 (Vasectomy, Unilateral or Bilateral (Separate Procedure), Including Postoperative Semen Examination(s)). This code does not need to be appended with modifier -50. Modifier -50indicates that the procedure was performed bilaterally. In other words, code 55250 indicates that the procedure performed either unilaterally or bilaterally. Code 55200 is also incorrect because it is used for a vasotomy not the excision of the vas deferens (a vasectomy).

Question 20

PROCEDURAL NOTE PATIENT: Ray, Alexander
AGE: 59
DATE: 02/15/2015
PREOPERATIVE DIAGNOSIS: Prostate Cancer, Primary
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE: TURP
A patient was placed in supine position on the operating table, draped and anesthetized accordingly. Using a resectoscope with light source, the physician located the prostate and resected the malignant prostatic tissue with electrocautery knife, leaving the appropriate margins. The physician removed the resectoscope and the patient was catheterized for drainage of his bladder contents and resected prostatic tissue. The patient tolerated the procedure well and was transferred to postoperative recovery. What is the correct code for this surgical procedure?

Accepted Answer

The correct code for this surgical procedure is 52601 (Transurethral Electrosurgical Resection of the Prostate Including Control of Postoperative Bleeding, Complete). The procedure TURP stands for transurethral resection of the prostate, which is the procedure described in the procedural note. Code 52500 is only used for the resection of a bladder neck not the prostate. Code 52630 is used for the regrowth of prostatic tissue and modifier-58 is inappropriate because it is used for the primary procedure.

Quiz 2: Series