Urology Coding Course Final Assessment

  • This is not a pass/failure test. This is strictly a test to identify any areas in which you have a misunderstanding of the rules or need additional expertise.

    There should be zero tolerance for mistakes in billing.
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  • 1. A new Medicare patient was seen in the office with Hx Gross hematuria. A medically appropriate H & P was performed and documented. Urine-blood tinged -RBCs TNTC CT scan viewed and was negative. Patient scheduled for cystoscopy. Which is the correct billing for this encounter?*
  • 2. A patient with history of Gross hematuria was scheduled for a routine cystoscopy. A tumor on the trigone of the bladder was identified. Patient was informed of the findings. The physician spent an additional 14 minutes explaining the problem and the recommended procedure for treatment. Which is the correct billing for this encounter?*
  • 3. What is the correct ICD-10 diagnoses for the above scenario (tumor on the trigone of bladder)?*
  • 4. Patient is in the clinic preparing for a scheduled TURBT in an ASC in the AM. A complete history and physical was performed and documented. CBC was normal. Surgery and potential complications were discussed in detail, including the possibility of chemotherapy intravesical infusion. Which is the correct billing for this encounter?*
  • 5. Patient, scheduled for TURBT, was reevaluated in the outpatient department and there was no change. Patient ready for surgery. Under anesthesia, a TUR of a 4 cm pedunculated tumor was removed from the trigone of the bladder and 4 biopsies were taken from the base of the tumor to determine if the tumor was invasive. After surgery 10 minutes were spent in explaining the procedure and the findings. Which is the correct billing for this encounter?*
  • 6. What is the correct ICD 10 diagnosis for the above scenario in #5?*
  • 7. Patient had a low-grade transitional cell tumor removed from the trigone of the bladder six months ago. Doing fine. Biopsies of the base showed no evidence of residual tumor. He has no problems. Urinalysis normal. Surveillance cystoscopy today; no evidence of tumor. What is the correct ICD-10 diagnosis for this encounter?*
  • 8. A new patient with frequency, urgency and nocturia was evaluated. He stated that the symptoms had been getting worse over the past year and a half. A decision was made to perform an ultrasound for residual during the visit. UA normal. Ultrasound showed 30 mL residual. Samples of a medication were given. A medically appropriate H & P was documented. Which is the correct billing for this encounter?*
  • 9. A patient was evaluated in the ER for right renal trauma and multiple additional injuries. An extended HPI (4+ points), complete ROS &  PFSH & comprehensive PE was performed and documented in EMR. CT scan was ordered and personally reviewed, revealing a 3.5 cm laceration of the right kidney. A decision was made to admit the patient and schedule for an exploration and repair surgery later today when patient is stable. Which is the correct billing for this encounter?*


  • 12. Procedures performed on 35-year-old male with two separate calculi: ▸ Cystoscopy, right retrograde to confirm location of stones. ▸ Ureteroscopy with lithotripsy .5 stone - mid right ureter. ▸ Ureteroscopy with lithotripsy .7 stone - right renal pelvis. ▸ Insertion of a right renal indwelling stent. Which is the correct billing for these procedures?*

  • 14a. A ureteroscopy lithotripsy of a 1 cm right upper calyx stone and a ureteroscopy lithotripsy of .5 cm lower ureteral stone was performed on a Medicare patient. A ureteral stent was inserted. Can you charge for both procedures?

  • 15a. Cystoscopy was performed on a Medicare patient in the office in the a.m.TUR of a 5.5 CM bladder tumor was performed in the afternoon under anesthesia as an outpatient at the hospital. Can you charge for both procedures?*

  • 16a. Same scenario as #15, except patient is a 45-year-old with private insurance. Can you charge for both procedures?*

  • 17. A 45-year-old female presents with a 2-day history of intermittent gross hematuria. No pain or fever.  No frequent or dysuria. Mother had cancer in the breast.  Bladder is not distended and is non tender. No Flank tenderness. Urethra is normal in location and consistency. No pelvic masses. Respiratory rate is normal. Patient appears to be well developed, well nourished and in no distress. Femoral pulse normal. Abdomen soft. A decision was made to proceed with a cystoscopy at the same encounter since patient's urine was grossly bloody. Cystoscopy revealed blood coming from the right ureteral orifice. An op report was documented. CT scan ordered. Which is the correct billing for this encounter?*
  • 18. Patient had an excision of left hydrocele 2 months ago. Developed right flank pain two days ago. Fever this a.m. Patient has rebound tenderness on the right. Temp 103. Evaluated with CT scan performed in the office; found to have a 6 mm stone at the UPJ. A complete history (5th level) was documented. Patient has cardiovascular problems and mild COPD. To see cardiologist this afternoon. Patient scheduled for ESWL on the Rt UPJ stone in a.m. Select the correct code set.*
  • 19a. Same patient in scenario #18 presents the next day and an ESWL procedure was performed on the Rt UPJ stone. Do you need a modifier to bill the procedure?*

  • 20. Patient had a TURP two months ago. A level III E&M (99213) was performed. Cystoscopy with irrigation of clots was performed in a dedicated endoscopy suite. Catheter was left indwelling. Which is the correct billing for this encounter?*
  • 21. I was asked by Doctor PCP to see a 45-year-old male admitted with severe, intermittent, right flank pain that started five hours ago. Nausea, but no vomiting. Complete PFSH and ROS were reviewed from admitting H&P on 5/6/17.  There has been no change. A comprehensive PE was performed.Data: CT 5mm stone UPJ: UA- RBC’s TNTC; BUN, creatinine, normalDx – Stone Rt UPJPlan – ESWL as an outpatient in two days. Surgery and complications explained to patient and family. Which is the correct billing for this encounter?*
  • 22. Patient received a vasectomy 10 weeks ago. States he is having hematospermia present during intercourse. The post surgery sperm analysis showed decreased motility. Physician performs another sperm analysis at the visit. Patient was reassured and was cleared for sexual intercourse. Which is the correct coding for this visit?*
  • 23. I was asked by Doctor PCP to see a 71-year-old male admitted with urinary retention. History of poor stream, nocturia times three and straining to urinate for two years. Urine clear, abdomen soft, catheter draining.Plan – evaluate upper tracks, then cystoscopy. Problem and potential treatment explained to patient and family. Total floor time 25 minutes. Over 50% of the time was spent in counseling and coordinating. Select the correct CPT code?*
  • 24. A 66-year-old male patient in acute distress arrives unaccompanied to the ER after falling. Urologist was asked to perform an assessment. Patient has tenderness in the Rt flank. CT viewed by the Urologist. Patient was unable to give adequate history. Urologist spent 45 minutes in the ER but no history was able to be achieved. Can the urologist bill an ER visit based on time?*
  • 25a. Patient had an ESWL of a stone in the Rt kidney two months ago. At that time it was documented in the op report that patient had a 1 cm stone in the Lt kidney that would require and ESWL. An ESWL of a 1 cm Lt renal calculus was performed today.    Do you need a modifier to charge for the procedure?*


  • 27. Dr. Jones, the primary surgeon, performed a retroperitoneal trans abdominal lymphadenectomy; extensive, including pelvic, aortic, and renal nodes in a non-teaching hospital. Dr. Smith assisted. Dr. Jones performed the surgery on the left side and Dr. Smith performed the surgery on the right side with Dr Jones assisting. Select the correct code set.*
  • 28. Patient is 6 weeks postop ESWL right renal calculus. Having problems with right flank pain, started two hours ago and is intermittent. No frequency, urgency, Right flank tenderness to percussion. Abdomen soft, vital signs normal. Ultrasound shows obstruction mid ureter with mild Hydro. UA RBC’s TNTCDX – Rule fragment of stone. Plan – CT scan. Pain medication ordered. Which is the correct billing for this encounter?*


  • 31. On a 70-year-old Medicare patient, a ureteral lithotripsy of a .4cm stone in the upper calyx of the right kidney was followed by the basketing and removal of that same stone. Ureteral stent was also inserted. What is the correct billing of this encounter?*
  • 32. Patient returns today for one year follow-up cancer of prostate. Doing fine. No bone pain or weight loss, voiding with a good stream. Rectal exam, no evidence of cancer. PSA unchanged. Will continue on LHRH, same dose. Which is the correct billing for this encounter?*

  • 34. What E&M Level is the following scenario? --45 yr old pt --Developed painless gross hematuria 2 days ago --Partially cleared --No frequency, urgency or dysuria --No chills or fever --UA few WBCs, RBCs numerous, grossly clear --Ordered CT and cytology
  • 35. What E&M Level is the following scenario? --New Pt, recently moved, not seen in past 6 most --PCa dx 4 yrs ago with bone mets --HRPCa good response to Xtandi 2 yrs ago --No obstructive symptoms --Continue Xtandi 160mg po q day --Scheduled for Eligard and Xgeva --f/u one month with PSA
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