URINARY, MALE, FEMALE GENITAL, MATERNITY

50,000 Series Questions Time: 30 x 2 minutes = 60 minutes

1. A 47-year-old male patient has urinary incontinence. Sling procedure was performed
six months ago and now returned for a revision of the Sling procedure. Identify the correct
code number for this procedure?
a. 53440
b. 53449
c. 53442
d. 53431

2. A blighted ovum, resulting in prolonged retension of the embryo in the 1st half
of the pregnancy was terminated by gynecologist. Identify the correct code number for
this procedure?
a. 59856
b. 59840
c. 59820
d. 59812

3. Urologist performed radical nephrectomy of right kidney laparoscopically in a

female patient with age of 53 years, but did not dissect adrenal gland. Identify the correct
code number for this procedure?
a. 50545-52
b. 50545
c. 50220-52
d. 50220

4. A patient underwent a complex cystometogram with bladder voiding pressure study

and a urethral EMG. Identify the correct code number(s) for this procedure?
a.51728, 51784-91
b. 51725, 51785-51
c. 51726, 51784-51
d. 51728, 51784-51

5. Patient has consented for further testing to determine the extent of her cervical
dysplasia. A cervical cone biopsy of endocervical tissue was cut using a laser. It was tagged
with a single stitch. Dilation and curettage was performed. Small amount of tissue was
obtained and sent to pathology. Identify the correct code number(s) for this procedure?

a. 57520, 58120
b. 57500
c. 57520
d. 57500, 57505

6. Newborn male is scheduled for a circumcision. He is sterilely prepped and draped; a

penile nerve block is performed. The circumcision is performed by a ring device. Hemostasis
is achieved. Vaseline Gauze dressing applied. Patient tolerated the procedure well. Identify
the correct code number(s) for this procedure?

a. 54160
b. 54150
c. 54161, 64450
d. 54150, 64450

7. A 39-year-old patient underwent anterior colporrhaphy repair of cystocele and

repair of the urethrocele and inserted mesh. The procedure was completed via vaginal
approach. How do you code for this surgery?
a.57240, 57267
b. 57250, 57267
c. 57240, 57267-51
d. 57240, 49568-51

8. A newborn male had an elective circumcision before home discharge from the
newborn nursery. The physician uses a ring block for the local anesthetic and the foreskin is
placed over the glans. A clamp is selected for the size of the glans and a constricting circular
ring is placed over the foreskin to compress and devascularize the foreskin. The
devascularized foreskin is excised with a scalpel, the ring device is removed, and the penis is
dressed. Identify the correct code number(s) for this procedure?

a. 54150
b. 54160
c. 54161
d. 54150-52

9. A 29-year-old who is pregnant at 39 weeks and 3 days is presenting for a low

transverse cesarean section. An abdominal incision is made and was extended superiorly
and inferiorly with good visualization of the bladder. The bladder blade was then inserted
and the lower uterine segment incised in a transverse fashion with the scalpel. The bladder
blade was removed and the infant's head delivered atraumatically. The nose and mouth
were suctioned with the bulb suction trap and the cord doubly clamped and cut. The
placenta was then removed manually. What code should be reported for this procedure?
a. 59610
b. 59510
c. 59514
d. 59515

10. A 61-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. Identify the correct code number(s) for this procedure?
a. 50543
b. 50547
c. 50300
d. 50320

11. A 52-year-old female has a symptomatic rectocele. She had been admitted and
taken to the main OR. An incision is made in the vagina into the perineal body (central
tendon of the perineum). Dissection was carried underneath posterior vaginal epithelium all
the way over to the rectocele. Fascial tissue was brought together with sutures creating a
bridge and the rectocele had been reduced with good support between the vagina and
rectum. What should be the correct procedure code number?
a. 45560
b. 57284
c. 57250
d. 57240

12. A 23-year-old female in the OR for ectopic pregnancy. Once the trocars were place a
pneumoperitoneum was created and the laparoscope introduced. The left fallopian tube
was dilated and was bleeding. The left ovary was normal. The uterus was of normal size,
shape and contour. The right ovary and tube were normal. Due to the patient’s body habitus
the adnexa could not be visualized to start the surgery. At this point the laparoscopic
approach was terminated. The pneumoperitoneum was deflated, and trocar sites were
sutured closed. The trocars and laparoscopic instruments had been removed. Open surgery
was performed incising a previous transverse scar from a cesarean section. The gestation
site was bleeding and all products of conception and clots were removed. The left tube was
grasped, clamped and removed in its entirety and passed off to pathology. Identify the
correct code number(s) for this procedure?
a. 59150, 59120
b. 59151
c. 59121
d. 59120

13. A 20-day-old baby boy 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. Identify appropriate surgery code number for this
procedure?
a. 54150
b. 54160
c. 54163
d. 54164

14. Code the procedure for cystourethroscopic resection of bladder tumor 3cm size
situated adjacent to the left urethral orifice by fulguration.
a. 52234
b. 52235-LT
c. 52235
d. 52285

15. Code the complete left renal transplantation procedure performed in a patient
suffering with chronic renal failure. The surgeon performed the procedure by harvesting the
left kidney of a living donor by laparoscopy, and after standard backbench preparation
without any reconstruction. The non functional left kidney of the patient, who had right
nephrectomy 2 years before was also done during the same session.
a. 50325-LT, 50360-LT, 50320-LT
b. 50325-LT, 50365-LT, 50320-LT
c. 50365-LT, 50325-LT, 50547-LT
d. 50365-LT, 50325-LT, 50547-LT

16. An urologist performed transurethral electrosurgical resection of prostrate in a

patient on the first day. On the next postoperative day, he performed vasectomy and
urethral dilation of prostatic urethra. Identify the correct code number(s) for this
procedure?
a. 52601
b. 52601, 52601, 55250-59
c. 52601, 52600, 55250-59
d. 52601, 52600-58, 55250-58-59

17. A gynecologist performed instillation of a topical antifungal agent in the vagina of a

patient who is having history of allergy to imidazole group of oral antifungal agent. Identify
the correct code number for this procedure?
a. 57180
b.57010
c.57150
d.57155

18. Patient presents to the hospital with right urethral calculus. Patient is taken to the
operating room where a cystoscopy with ureteroscopy is performed to remove the calculus.
Identify the correct code number for this procedure?
a. 52353
b. 52310
c. 51065
d. 52352

19. Patient comes to the hospital with a history of right flank pain. Urine tests are
negative. Radiology examination reveals that the patient has renal cysts. Patient is now
admitted for laparoscopic ablation of the cysts. Identify the correct code number for this
procedure?
a. 50541
b. 50390
c. 50280
d. 50920

20. Patient has extensive bladder cancer. She underwent a complete cystectomy with
bilateral pelvic lymphadenectomy and creation of ureteroileal conduit. Identify the correct
code number for this procedure?
a. 51575; 50820
b. 50825; 51570; 38770
c. 51595
d. 51550; 38770

21. OPERATIVE REPORT

PREOPERATIVE DIAGNOSIS: Right ureteral stricture. POSTOPERATIVE DIAGNOSIS: Right
ureteral stricture.
PROCEDURE PERFORMED: Cystoscopy, right ureteral stent change.
PROCEDURE NOTE: The patient was placed in the lithotomy position after receiving IV
sedation. He was prepped and draped in the lithotomy position. The 21 French cystoscope
was passed into the bladder, and urine was collected for culture. Inspection of the bladder
demonstrated findings consistent with radiation cystitis, which has been previously
diagnosed. There is no frank neoplasia. The right ureteral stent was grasped and removed
through the urethral meatus; under fluoroscopic control, a guide wire was advanced up the
stent, and the stent was exchanged for a 7 French 26-cm stent under fluoroscopic control in
the usual fashion. The patient tolerated the procedure well. Identify the correct code
number(s) for this procedure?
a. 51702-LT, N13.5
b. 51702-RT, N30.90
c. 52332-RT, N30.90
d. 52332-RT, N13.5

22. This patient is 35 years old at 36 weeks’ gestation. She presented in spontaneous
labor. Because of her prior cesarean section, she is taken to the operating room to have a
repeat lower-segment transverse cesarean section performed. The patient also desires
sterilization, and so a bilateral tubal ligation will also be performed. A single liveborn infant
was the outcome of the delivery. Identify the correct code number(s) for this procedure?
a. 59510, 58600-51, Z30.2
b. 59620, 58615-51, O60.14X2, Z37.0
c. 59514, 58605-51, Z37.0, O60.14X2
d. 59514, 58611, O60.14X2, O34.21, Z37.0, Z30.2

23. This 12-month-old boy has a midshaft hypospadias with a very mild degree of
chordee. He also has a persistent right hydrocele. The surgeon brought the boy to surgery
to perform a right hydrocele repair and one-stage repair of hypospadias with prepucial flap.
Identify the correct code number(s) for this procedure?
a. 54322, 55040, Q54.9, Q54.4
b. 54322, 55041-51, Q54.9, Q54.4, N43.3
c. 54324, 55060-51, Q54.9, Q54.4, N43.3
d. 54324, 55060, Q54.4, N43.3

24. The pediatric physician takes this newborn male to the nursery to perform a
clamp circumcision. Identify the correct code number(s) for this procedure?
a. 54160, Z41.2
b. 54150
c. 54160
d. 54150, Z41.2
25. Preoperative Diagnosis: Right hydronephrosis Postoperative Diagnosis: Right
hydronephrosis Operation: Cystoscopy and right retrograde pyelogram
Procedure: Patient prepped and draped in the dorsolithotomy position. Placed under
general anesthesia a 23 French cystoscope was passed into the bladder. No tumors were
visualized. Urine from the bladder was sent for urine cytology. Then a 6 French access
catheter was passed into the right ureteral orifice. Contrast was injected and there were no
filling defects noted. There was no fixed tumor and no stone. There was mild hydroureteral
nephrosis against the bladder. There was a narrowing at the UVJ no abnormalities. Renal
pelvis barbotaged with saline and renal pelvis urine sent to pathology for urine cytology.
After the retrograde pyelogram was performed the access catheter was removed. Identify
the correct code number(s) for this procedure?

a. 52000-RT, 74420-26
b. 52281-RT, 74425-26
c. 52007-RT, 74400-26
d. 52005-RT, 74420-26

26. Percutaneous radiofrequency ablation of a renal tumor is defined by which of the

following code number?
a. 50250
b. 50592
c. 50593
d. 49203

27. Assign the correct code for percutaneous cryotherapy of a renal tumor?
a. 50250
b. 50592
c. 50593
d. 49203

28. A 73-year-old female with history of cervical carcinoma underwent placement of an

ileal conduit, with subsequent development of left hydronephrosis. A retrograde ureteral
catheter was recently placed. She returns today for catheter exchange. Patient was placed
in the supine position. The ileal conduit was accessed. The existing catheter was removed
over a guidewire and replaced with a similar 10 French 50 cm long locking pigtail catheter.
Contrast was injected, confirming good position.
IMPRESSION: Left retrograde ureteral catheter exchange via the ileal conduit.
Identify the correct code number(s) for this procedure?
a. 50435, 75984
b. 50693
c. 50385
d. 50688, 75984
.
29. A surgeon performs a diagnostic laparoscopy followed by a laparoscopic
nephrectomy (including partial ureterectomy). Identify the correct code number(s) for this
procedure?

a. 50546
b. 49320, 50546-51
c. 49320
d. 50549

30. A physician performed combined anterior and posterior colporrhaphy. How do you
code for this procedure?
a. 57240
b. 57250
c. 57260
d. 57265