Genital System

Male/Female Genital System (Series 50000)
Question 1
45 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. The correct CPT® code is:
A. 50543
B. 50547
C. 50300
D. 50320
Rationale: The answer is B. This is a surgical laparoscopic procedure for removing the kidney
(nephrectomy), eliminating multiple
choice answers C and D. The whole kidney was taken out from a donor and put on ice (cold
preservation), eliminating multiple choice answer A.
Question 2
5 year-old male with a history of prematurity was found to have a chordee due to congenital hypospadias.
He presents for surgical management for a plastic repair in straightening the abnormal curvature. Under
general anesthesia, bands were placed around the base of the penis and incisions were made degloving
the penis circumferentially. The foreskin was divided in Byers flaps and the penile skin was
reapproximated at the 12 o’clock position. Two Byers flaps were reapproximated, recreating a mucosal
collar which was then criss- crossed and trimmed in the midline in order to accommodate median raphe
reconstruction. This was reconstructed with use of a horizontal mattress suture. The shaft skin was then
approximated to the mucosal collar with sutures correcting the defect. Which CPT® code should be
used?
A. 54304
B. 54340
C. 54400
D. 54440
Rationale: The answer is A. Patient does not have a penile injury, eliminating multiple choice D. The
patient is not having an insertion of a penile prosthesis, eliminating multiple choice C. The surgery is not
correcting a hypospadias
complication such as a fistula, stricture, or diverticula, eliminating multiple choice answer B. The correct
answer is A, 54304.
Question 3
A 25 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. What code(s) is (are) reported for this procedure?
A. 59150, 59120
B. 59151
C. 59121
D. 59120
Rationale: The answer is D. Procedure had started with a laparoscopic treatment for a tubal ectopic
pregnancy. Due to the patient’s body size the laparoscopic approach was terminated and an open surgery
was performed instead,
eliminating multiple choice answers A and B. The patient had the left fallopian tube removed
(salpingectomy) removed, eliminating multiple choice answer C. When an laparoscopic surgical
procedure fails, only the successful open procedure is reported (NCCI Manual, version 6.1, April-June,
2000).
Question 4
A neonatal male had an elective circumcision before being discharged home 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 and the clamp is left
in place. Which CPT® code should be used?
A. 54150
B. 54160
C. 54161
D. 54150-52
Rationale: The answer is A. In the CPT® Index, look for Circumcision/Surgical Excision/Neonate. You
are referred to 54150, 54160.
Review the codes to choose appropriate service. 54150 is the correct code because the circumcision was
performed with a ring block and a clamp for the procedure. CPT® codes 54160 or 54161 is not reported
because that is for a circumcision not using a clamp, device or dorsal slit. A parenthetical note under code
54150 states to append modifier 52 when the circumcision is performed without dorsal penile or ring
block.
Question 5
67 year-old 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. What CPT® code(s) is (are) reported?
A. 57288
B. 57287
C. 57288, 52000-51
D. 51992, 52000-51
Rationale: The answer is A. Removal or revision of the sling is not being performed, eliminating multiple
choice answer B. The
procedure was an open surgery, eliminating multiple choice answer D. Cystoscopy procedure code is a
separate procedure. According to CPT® Surgery guidelines, the codes designated as a “separate
procedure” should not be reported in addition to the code for the total procedure or service of which it is
considered an integral component.” Meaning that the cystoscopy is included with the sling operation
procedure because it was performed in the same surgical session.

Genital System

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Male/Female Genital System (Series 50000)

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