CPT Chapter 12: Urinary System – Flashcards

The removal of a kidney stone by making an incision in the kidney is known as a(n)______

During a percutaneous drainage of renal abscess, a CAT scan or__________is used to guide the placement of a drainage needle.

A single structure known as the_________is a mucous membrane-lined tube that transports urine from the bladder to be excreted from the body.

A partial removal of the kidney is known as a(n)___________.

Plastic surgery that is completed on the renal pelvis of the kidney is known as_________.

Nephrorrhaphy is_________of the kidney.

Surgical laparoscopic procedure codes for procedures completed on the ureters always include a(n)_________.

Codes 50951 to 50961 are used to report endoscopy ureteral procedures completed though an establisted_________.

The study of the holding and storage of urine in the bladder, the motion and rate of the movement of the urine, and the analysis of how the bladder empties is called________.

Codes 52000 is a separate procedure code and is used to report a(n)__________.

Ureterolithotomy involving the upper one-third of the ureter

Ureterectomy with bladder cuff

Percutaneous needle biopsy of the kidney

Excision of perinephric cyst

Open drainage of renal abscess

Partial nephrectomy

Unroofing of cyst of kidney

Partial cystectomy

Ureteral endoscopy by means of ureterotomy with removal of calculus

Cystourthroplasty with bilateral ureteroneocystostomy

Cystourethroscopy

Drainage of deep periurethral abscess

Insertion of tandem cuff

Urethromeatoplasty with partial excision of distal urethral segment

Complex uroflowmetry

Ureterotomy with drainage

Extracorporeal shock wave lithotripsy

Ureterolysis for ovarian vein syndrome

Closure of pyelocutaneous fistula

Cystourethroscopy with transurethral resection of ejaculatory ducts

Initial dilation of female urethra, including suppository and installation

Excision of Skene's glands

Closure of vesicovaginal fistual; abdominal approach

Cystotomy with insertion of ureteral catheter

CASE 1: Procedure: Ureteroscopy of left ureter for removal of calculus; stent placement. The patient was taken from the presurgery area to the operating room and prepped and draped in the usual fashion. General anesthesia was administered. The endoscope was placed into the urethra, which appeared to be inflamed. The scope was the carefully passed though the bladder, which appeared normal. The guidewire was introduced, and a balloon was used to dilate the left ureter. The scope was advanced to view the ureter, where a small stone was extracted and a stent was placed. The area was checked for bleeding, and the scope was then removed. The stent was attached to a string, which was in the correct position. Blood loss was minimal, and the patient was sent to the recovery room in good condition.

CASE 2: Procedure: Dilation of urethra, first attempt This 45-year-old male patient was brought to the operating room and prepped and draped in the usual fashion. After the patient was anesthetized, a urethral dilator was unserted into the urethra. The urethra was then dilated to normal range.

CASE 3: The patient is a 70-year-old female with a history of bladder cancer. She present today for a cystoscopy, biopsy, and fulguration of an erythematous area that appeared suspicious in previous testing. The area is the right trigone. The patient was placed in the supine position, where spinal anesthesia was administered. Sje was then turned to the dorsal lithotomy position, where she was prepped and draped in the usual sterile manner. A 22French cystoscopy sheath was passed in atraumatic fashion per the urethra. The bladder was resented with the 70-degree lens, and the right trigone area was found slightly erythematous and hypervascular. No tumors were found, and no mucosal abnormalities were noted. A biopsy of the area was taken and sent for pathology.

CASE 4: A 68-year-old male presents today for laser coagulation of the prostate due to urinary retention with urgency and difficulty urinating. Procedure: The patient was placed on the operating table in the lithotomy position. Spinal anesthesia was administered, and external genitalia was prepped and draped. A 21-French cystoscope was introduced into the bladder. Upon inspection, there was no evidence of a tumor. Mild trabeculations were observed on both ureteral orifices. The retroscope was introduced with a resection of the lateral lobes of the prostate bring done; complete opening of the prostatic urethrra was allowed smoothed out with the VaporTrode. An indwelling Foley catheter ws inserted into the bladder.

CASE 5: Procedure; Ureteral Catherization via scope. Patient was place in the lithotomy positison after administration of general anesthesia. A size 22 cystoscope with a 30-degree lens was placed with care under direct visualization. A lighted catheter was placed to the side for the scope, and then the left ureteral orifice was visualized. The lighted catheter was moved to the ureteral orifice and then advanced into the left renal pelvis without and problems or difficulty. After this, the cystoscope was removed. The lighted catheter was then connected to the light source. A size 18 Foley catheter was inserted into the bladder without any difficulty, and in balloon, the fluid was 10 cc. There was no blood loss during surgery, and the patient was taken to the recovery area in good condition.

CASE 6: Procedure: Bladder aspiration with suprapubic tube placement. The patient was brought to the operating room and placed in the supine position. Anesthesia was administered, and the patient was then moved to the dorsal lithotomy position. He was prepped and draped in normal sterile fashion after the Foley catheter was removed. A cystoscopy was used to explore the bladder for tumor or other foreign bodies. None were identified. The bladder was then filled with about 500cc of sterile water, which allowed for identification of the tract needed to insert the Rauch suprapubic trocar. The skin was anesthetized with Marcaine and Lidocaine. A needle was then inserted though the lower adbominal wall into the bladder, and the trocar was advanced until the sheath of the trocare was in the bladder. A 16 French catheter was placed though the sheath into the bladder, and the balloon was inflated with 10 cc of sterile water. The sheath was then removed, and we noted good placement of the suprapubic tube in the bladder. The tube was then secured with 0 prolene suture, and the skin incision was cauterized and hemostasis was achieved. The patient was transferred to the recovery room in good condition.

CASE 7: The patient was place on the procedure table in the supine position with conscious sedation of Versed being given. The patient was then placed in the lithotomy position. She was prepped and draped in normal sterile fashion. A 22 French cystoscopy sheath was passed though the urethra in atraumaticc fashion. The bladder was resected with the 70-degree lends. The urethra was normal, the bladder was 1+ trabeculated, the lower-right portion of the trigone were erythematous and hypervascular. No papillary tumors or masses were found. No mucosal abnormalities were noted. A total of three cup biopsies were taken using forceps from the erythematous area of the trigone and sent to pathology. The area was fulgurated with the Bugby electrode, no active bleeding was encountered. The pathology came back as chronic cystitis.

CASE 8: Anesthesia: Conscious sedation under supervision of urologist for 45 minutes. Procedure: Extracorporeal shock wave lithotripsy The patient was placed on the treatment table, and a water cushion was placed over the location of the kidney stone. X-rays were then taken to determine the exact location of the stone, which was then treated with a total of 3,200 shocks, Films confirmed that the stone was pulverized into small fragments. There were no complications, and the patient was sent to the recovery area.

CASE 9: Procedural Note: After the patient was prepped, draped, and anesthetized, he was placed in the lithotomy position. A cystourethroscope was inserted though the urethra into the bladder. In the bladder, there was a large amount of tumor that was then fulgurated via electric current. The tumor was noted to be 3 cm in size. There was minimal blood loss. The patient tolerated the procedure well and was sent to recovery in stable condition.

CASE 10: A cystourethroscope was passed though the urethra into the bladder. The urethra, bladder, and ureteric openings were carefully visualized for any evidence of cancer recurrence. The examination showed all structures to be normal with no evidence of cancer at this time. The scope was withdrawn, and the patient was sent to the recovery area in satisfactory condition.