OST-249: Chapter 10 - Male & Female
Reproductive, Maternity and Delivery,
and Endocrine System (50000 Series)
Exam
A 2-month-old male for circumcision. An incision was made at the level of the corona. The
foreskin was removed from the shaft of the penis with pickups and Matzenbaum scissors after
dividing the frenular band with mosquito clamps. - Answer 54161
(Circumcision was performed by surgical excision, which codes to 54161 when performed to
other than an infant.) WRONG
Subumbilical incision and blunt cannula placed. The liver, bowel, and appendix appeared
normal. Right ovary had a 4 cm cyst which was aspirated and allowed to drain. - Answer
49322
(Aspiration of an ovarian cyst was performed laparoscopically, which is assigned 49322.)
Ultrasound probe was introduced into the rectum. Scanning performed and no abnormalities
were noted. Base of prostate was infiltrated and punch biopsies were taken of the base, mid,
and apex, medially and laterally from each lobe, for a total of 12 cores. - Answer 55700
(Code 55700 is assigned for any approach for needle or punch biopsy of the prostate.)
Guidewire was inserted in the right orifice (urethra) via cystoscopy, advanced to the right renal
pelvis following which the distal right ureter was dilated using a balloon dilator, size 10 cm, a #9
rigid ureteroscopy was introduced, and ureters were also examined. - Answer 52341-RT
(Cystourethroscopy was performed and balloon dilation of ureteral stricture was performed,
which codes to 52341-RT.) WRONG
Cystoscope sheath was introduced and urethra and bladder mucosa were noted as normal. An 8
French catheter was placed into the right ureteral orifice and showed narrowing of the right
ureter. French double pigtail ureteral stent was placed over the wire. - Answer 52332-RT
(Diagnostic cystourethroscopy performed; however, when surgical procedure performed
through same approach, diagnostic not coded. Therefore, only 52332-RT, cystourethroscopic
insertion of a ureteral stent is assigned.) WRONG
74 year old with suprapubic abdominal pressure. Urinary catheter was placed and left
indwelling until drained completely. - Answer 51702
(Insertion of an indwelling urinary catheter is assigned code 51702.)
, 2 cm infraumbilical incision was performed and peritoneum insufflated, trocar introduced, and
scope introduced. Endometriosis of the right ovary was identified and laser apparatus was used
to ablate the endometriotic implants on the left uterosacral and cul-de-sac area. - Answer
58662
(Procedure was performed laparoscopically to ablate lesions of the peritoneal surface,
therefore, assign code 58662.)
Physician performs sling repair for urinary stress incontinency along with A & P repair. Synthetic
mesh was used for both. - Answer 57288, 57260-51, 57267-59
(A & P repair was performed (57260) as well as sling repair (57288). 57267 is an add-on code,
and, therefore, does not require the use of the multiple procedure modifier. However, modifier -
59 should be appended as the mesh insertion was separate and distinct from the sling
procedure (performed on both).)
Female having urinary incontinence with intrinsic sphincter deficiency is having a cystoscopy
performed with a placement of a sling. An incision was made over the mid urethra dissected
laterally to urethropelvic ligament. Cystoscopy revealed no penetration of the bladder. The
edges of the sling were weaved around the junction of the urethra and brought up to the
suprapubic incision. A hemostat was then placed between the sling and the urethra, ensuring
no tension. - Answer 57288
(Diagnostic cystoscopy would be included in the procedure. Assign code 57288 only.)
Cystoscopy, stone extraction. Cystoscope was introduced. There were stones lodged in the
prostatic urethra. They were pushed back with the scope into the bladder. The stones were
removed. There were no further stones found. - Answer 52310
(Cystoscopic removal of stones would be assigned 52310. No mention of retrograde pyelogram;
therefore, code 74420 would not be appropriate.)
Incision of bladder neck contraction. Using the resectoscope, the urethra and bladder were
inspected and he had a 10 French bladder neck contracture. Guidewire was inserted through
the contracture and using the Collins knife cutting at the 2, 10, 7, and 5 o'clock positions, the
bladder neck was opened. - Answer 52500
(Bladder neck contracture is assigned from the vesical neck section of the urinary surgical
section, transurethral resection of bladder. Code 52500)
Patient presents for cystoscopy and sling procedure for stress urinary incontinence. Additional
determination for diagnosis of stress urinary incontinence is determined by what? - Answer
stress versus stress and urge
(ICD-10 codes for urinary incontinence changed since ICD-9. Female/Male is no longer a
determining factor for urinary incontinence, however, ICD10 does distinguish between stress
incontinence and stress and urge incontinence with separate codes.) WRONG
Reproductive, Maternity and Delivery,
and Endocrine System (50000 Series)
Exam
A 2-month-old male for circumcision. An incision was made at the level of the corona. The
foreskin was removed from the shaft of the penis with pickups and Matzenbaum scissors after
dividing the frenular band with mosquito clamps. - Answer 54161
(Circumcision was performed by surgical excision, which codes to 54161 when performed to
other than an infant.) WRONG
Subumbilical incision and blunt cannula placed. The liver, bowel, and appendix appeared
normal. Right ovary had a 4 cm cyst which was aspirated and allowed to drain. - Answer
49322
(Aspiration of an ovarian cyst was performed laparoscopically, which is assigned 49322.)
Ultrasound probe was introduced into the rectum. Scanning performed and no abnormalities
were noted. Base of prostate was infiltrated and punch biopsies were taken of the base, mid,
and apex, medially and laterally from each lobe, for a total of 12 cores. - Answer 55700
(Code 55700 is assigned for any approach for needle or punch biopsy of the prostate.)
Guidewire was inserted in the right orifice (urethra) via cystoscopy, advanced to the right renal
pelvis following which the distal right ureter was dilated using a balloon dilator, size 10 cm, a #9
rigid ureteroscopy was introduced, and ureters were also examined. - Answer 52341-RT
(Cystourethroscopy was performed and balloon dilation of ureteral stricture was performed,
which codes to 52341-RT.) WRONG
Cystoscope sheath was introduced and urethra and bladder mucosa were noted as normal. An 8
French catheter was placed into the right ureteral orifice and showed narrowing of the right
ureter. French double pigtail ureteral stent was placed over the wire. - Answer 52332-RT
(Diagnostic cystourethroscopy performed; however, when surgical procedure performed
through same approach, diagnostic not coded. Therefore, only 52332-RT, cystourethroscopic
insertion of a ureteral stent is assigned.) WRONG
74 year old with suprapubic abdominal pressure. Urinary catheter was placed and left
indwelling until drained completely. - Answer 51702
(Insertion of an indwelling urinary catheter is assigned code 51702.)
, 2 cm infraumbilical incision was performed and peritoneum insufflated, trocar introduced, and
scope introduced. Endometriosis of the right ovary was identified and laser apparatus was used
to ablate the endometriotic implants on the left uterosacral and cul-de-sac area. - Answer
58662
(Procedure was performed laparoscopically to ablate lesions of the peritoneal surface,
therefore, assign code 58662.)
Physician performs sling repair for urinary stress incontinency along with A & P repair. Synthetic
mesh was used for both. - Answer 57288, 57260-51, 57267-59
(A & P repair was performed (57260) as well as sling repair (57288). 57267 is an add-on code,
and, therefore, does not require the use of the multiple procedure modifier. However, modifier -
59 should be appended as the mesh insertion was separate and distinct from the sling
procedure (performed on both).)
Female having urinary incontinence with intrinsic sphincter deficiency is having a cystoscopy
performed with a placement of a sling. An incision was made over the mid urethra dissected
laterally to urethropelvic ligament. Cystoscopy revealed no penetration of the bladder. The
edges of the sling were weaved around the junction of the urethra and brought up to the
suprapubic incision. A hemostat was then placed between the sling and the urethra, ensuring
no tension. - Answer 57288
(Diagnostic cystoscopy would be included in the procedure. Assign code 57288 only.)
Cystoscopy, stone extraction. Cystoscope was introduced. There were stones lodged in the
prostatic urethra. They were pushed back with the scope into the bladder. The stones were
removed. There were no further stones found. - Answer 52310
(Cystoscopic removal of stones would be assigned 52310. No mention of retrograde pyelogram;
therefore, code 74420 would not be appropriate.)
Incision of bladder neck contraction. Using the resectoscope, the urethra and bladder were
inspected and he had a 10 French bladder neck contracture. Guidewire was inserted through
the contracture and using the Collins knife cutting at the 2, 10, 7, and 5 o'clock positions, the
bladder neck was opened. - Answer 52500
(Bladder neck contracture is assigned from the vesical neck section of the urinary surgical
section, transurethral resection of bladder. Code 52500)
Patient presents for cystoscopy and sling procedure for stress urinary incontinence. Additional
determination for diagnosis of stress urinary incontinence is determined by what? - Answer
stress versus stress and urge
(ICD-10 codes for urinary incontinence changed since ICD-9. Female/Male is no longer a
determining factor for urinary incontinence, however, ICD10 does distinguish between stress
incontinence and stress and urge incontinence with separate codes.) WRONG
