Certified Professional Coder (CPC) Quiz: Assign Urinary Procedure Codes
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Assign Urinary Procedure CodesQuestion 1 of 20

A urologist performs an open partial nephrectomy to excise a 2.5 cm renal mass, preserving the rest of the kidney. Which CPT® code is reported?

50220
50230
50543
50240
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Certified Professional Coder (CPC) Quiz

Certified Professional Coder (CPC) Quiz: Assign Urinary Procedure Codes

Practice Assign Urinary Procedure Codes in Certified Professional Coder (CPC) with focused quiz questions that help you check what you know, review explanations, and build confidence with test-style prompts.

What this quiz covers

This quiz focuses on Assign Urinary Procedure Codes, giving you a quick way to practice the rules, question types, and explanations that matter most for Certified Professional Coder (CPC).

How to use this quiz

Try each quiz question before looking at the correct answer. Use the explanations to review missed ideas, then come back to similar questions until the pattern feels familiar.

All questions

Question 1

A urologist performs an open partial nephrectomy to excise a 2.5 cm renal mass, preserving the rest of the kidney. Which CPT® code is reported?

  1. 50220
  2. 50230
  3. 50543
  4. 50240 (correct answer)
Explanation: CPT® 50240 describes partial nephrectomy via an open approach — the correct code when only the tumor-bearing portion of the kidney is removed through an open incision. Code 50220 describes open total (simple) nephrectomy, which removes the entire kidney rather than preserving it. Code 50230 describes open radical nephrectomy with lymphadenectomy — also a total kidney removal with additional oncologic components. Code 50543 describes laparoscopic partial nephrectomy — the same nephron-sparing extent of resection but performed through a minimally invasive approach. When the procedure is a partial resection performed via an open incision, 50240 is the only code that captures both the partial extent and the open approach.

Question 2

A urologist performs a cystourethroscopy for diagnostic evaluation only, with no other procedures performed. Which CPT® code is reported?

  1. 52204
  2. 52000 (correct answer)
  3. 52005
  4. 52001
Explanation: CPT® 52000 describes cystourethroscopy as a diagnostic, separate procedure — no biopsy, no catheterization, no therapeutic intervention. Code 52204 describes cystourethroscopy with biopsy(ies), which moves beyond diagnostic evaluation to tissue sampling; if a biopsy is performed, 52000 is not reported. Code 52005 describes cystourethroscopy with ureteral catheterization, which adds a therapeutic or diagnostic catheter placement. Code 52001 describes cystourethroscopy with irrigation and evacuation of multiple obstructing clots. When only visualization is performed and no biopsy, catheter placement, or other procedure is added, 52000 is the correct code.

Question 3

During cystoscopy, the urologist resects a small bladder tumor measuring 1.5 cm. Which CPT® code is reported?

  1. 52224
  2. 52235
  3. 52240
  4. 52234 (correct answer)
Explanation: CPT® 52234 describes cystourethroscopy with fulguration and/or resection of a small bladder tumor, defined as 0.5 cm up to 2.0 cm — a 1.5 cm tumor falls within the small range. Code 52224 describes fulguration of minor lesions less than 0.5 cm, with or without biopsy; 1.5 cm exceeds the minor lesion threshold. Code 52235 describes medium tumor resection (2.0 to 5.0 cm); 1.5 cm is below the medium threshold. Code 52240 describes large tumor resection (greater than 5.0 cm). Correctly classifying the tumor into the small (52234), medium (52235), or large (52240) tier requires precise knowledge of the size boundaries: <0.5 cm = 52224, 0.5-<2 cm = 52234, 2-5 cm = 52235, >5 cm = 52240.

Question 4

A surgeon performs an open ureterolithotomy to remove a calculus lodged in the middle third of the ureter. Which CPT® code is reported?

  1. 50610
  2. 50630
  3. 50650
  4. 50620 (correct answer)
Explanation: CPT® 50620 describes open ureterolithotomy for a calculus in the middle one-third of the ureter. Code 50610 describes the same open procedure for a stone in the upper one-third of the ureter — the level of the stone within the ureter is the sole differentiator among 50610, 50620, and 50630. Code 50630 describes open ureterolithotomy for the lower one-third of the ureter. Code 50650 describes ureterectomy with bladder cuff, which is a resection of the ureter (removal of the structure), not a stone extraction. Identifying the location of the calculus within the ureter (upper, middle, or lower third) is required to select the correct open ureterolithotomy code.

Question 5

During cystoscopy, the urologist removes a ureteral calculus that has migrated into the distal ureter near the ureterovesical junction. Which CPT® code is reported?

  1. 52310
  2. 52320 (correct answer)
  3. 52330
  4. 52325
Explanation: CPT® 52320 describes cystourethroscopy with removal of a ureteral calculus — the correct code when the stone is located in the ureter (not inside the bladder or urethra) and is extracted via cystoscopic technique. Code 52310 describes removal of a foreign body, calculus, or ureteral stent from the urethra or bladder — not from the ureter. Code 52330 describes manipulation of a ureteral calculus without removal — moving the stone without extracting it. Code 52325 describes fragmentation of a ureteral calculus without complete retrieval. Distinguishing the location of the calculus (ureter vs. bladder/urethra) and the completeness of removal (extraction vs. manipulation vs. fragmentation) is critical for accurate cystoscopic stone management coding.

Question 6

A radiologist performs a percutaneous exchange (replacement) of an existing nephrostomy catheter under fluoroscopic guidance. Which CPT® code is reported?

  1. 50432
  2. 50433
  3. 50434
  4. 50435 (correct answer)
Explanation: CPT® 50435 describes exchange of a nephrostomy catheter, percutaneous, including diagnostic nephrostogram and imaging guidance — used when an existing nephrostomy tube is replaced over a wire without creating a new tract. Code 50432 describes initial placement of a nephrostomy catheter (creating a new percutaneous access tract); when the tract already exists and the catheter is simply exchanged, 50432 is not appropriate. Code 50433 describes placement of a nephrostoureteral catheter, which has a distal end extending into the ureter or bladder — a different type of catheter than a simple nephrostomy tube. Code 50434 describes conversion of an existing nephrostomy catheter to a nephrostoureteral catheter — a change in catheter type, not a like-for-like exchange. The distinction between initial placement (50432), exchange of same type (50435), and conversion to a different type (50434) is a high-frequency urologic coding distinction.

Question 7

A urologist performs a percutaneous nephrostolithotomy to remove a 1.8 cm renal calculus. Which CPT® code is reported?

  1. 50080 (correct answer)
  2. 50081
  3. 50060
  4. 50590
Explanation: CPT® 50080 describes percutaneous nephrostolithotomy or pyelostolithotomy for a stone up to and including 2 cm — a 1.8 cm stone is at or below the threshold. Code 50081 describes PCNL for a stone exceeding 2 cm; the 1.8 cm stone does not reach the 50081 threshold. Code 50060 describes open nephrolithotomy requiring surgical incision into the kidney, not a percutaneous approach. Code 50590 describes ESWL, which fragments stone by external shock waves without any skin incision. The 2 cm threshold is the single numeric differentiator between PCNL codes 50080 and 50081.

Question 8

A surgeon performs a ureteroneocystostomy, anastomosing a single ureter directly to the bladder following distal ureteral injury. Which CPT® code is reported?

  1. 50760
  2. 50780 (correct answer)
  3. 50770
  4. 50740
Explanation: CPT® 50780 describes ureteroneocystostomy — anastomosis of a single ureter to the bladder (ureterovesical reimplantation), the standard repair for distal ureteral injuries or vesicoureteral reflux. Code 50760 describes ureteroureterostomy, an anastomosis of two segments of ureter to each other rather than to the bladder. Code 50770 describes transureteroureterostomy, in which one ureter is anastomosed to the contralateral ureter — used when the ipsilateral bladder cannot be safely reached. Code 50740 describes ureteropyelostomy, an anastomosis of the ureter to the renal pelvis — performed for ureteropelvic junction obstruction, not distal ureteral repair. The terminus of the anastomosis (bladder, contralateral ureter, or renal pelvis) determines the correct code.

Question 9

A urologist performs a ureteroscopy with retrieval of a ureteral calculus using a stone basket, without fragmentation. Which CPT® code is reported?

  1. 52353
  2. 52356
  3. 52352 (correct answer)
  4. 52355
Explanation: CPT® 52352 describes cystourethroscopy with ureteroscopy and/or pyeloscopy with removal or manipulation of a calculus — the correct code when the stone is captured and removed intact by basket or forceps without any lithotripsy. Code 52353 describes ureteroscopy with lithotripsy (fragmentation) without stent placement; since no lithotripsy device was used, 52353 is incorrect. Code 52356 describes ureteroscopy with lithotripsy and stent placement; again, no lithotripsy was performed. Code 52355 describes ureteroscopy with resection of a ureteral or renal pelvic tumor — not applicable for calculus extraction. The method of calculus management (intact removal vs. fragmentation) and whether a stent is placed determine the selection among 52352, 52353, and 52356.

Question 10

A urologist performs a laparoscopic radical nephrectomy for a T2 renal cell carcinoma, including regional lymphadenectomy. Which CPT® code is reported?

  1. 50220
  2. 50230
  3. 50543
  4. 50545 (correct answer)
Explanation: CPT® 50545 describes laparoscopic radical nephrectomy — removal of the kidney and regional lymph nodes through a minimally invasive laparoscopic approach, equivalent in oncologic extent to the open radical procedure. Code 50230 describes open radical nephrectomy with lymphadenectomy — the same oncologic procedure but performed via an open incision. Code 50220 describes open simple nephrectomy without lymphadenectomy — neither the approach nor the extent matches a laparoscopic radical procedure. Code 50543 describes laparoscopic partial nephrectomy — laparoscopic but limited to partial resection of the kidney, not total with lymphadenectomy. Both the approach (laparoscopic) and the extent (radical with nodes) must be identified to select 50545.

Question 11

A urologist performs a complete transurethral electrosurgical resection of the prostate (TURP) as a first-time procedure. Which CPT® code is reported?

  1. 52601 (correct answer)
  2. 52630
  3. 52500
  4. 52450
Explanation: CPT® 52601 describes a complete transurethral electrosurgical resection of the prostate, including control of postoperative bleeding, for a first-time (not regrowth) procedure; meatotomy, cystourethroscopy, urethral dilation, and internal urethrotomy are included in the global service. Code 52630 describes transurethral resection of residual or regrowth obstructive prostate tissue after a prior TURP — a subsequent procedure, not an initial complete resection. Code 52500 describes transurethral resection of the bladder neck, not the prostate gland. Code 52450 describes transurethral incision of the prostate (TUIP), in which incisions are made without tissue resection, used for smaller prostates and a less morbid alternative to resection.

Question 12

Under fluoroscopic guidance, a radiologist places a percutaneous nephrostomy catheter (terminating in the renal pelvis) into a patient with ureteral obstruction. Which CPT® code is reported?

  1. 50393
  2. 50433
  3. 50435
  4. 50432 (correct answer)
Explanation: CPT® 50432 describes placement of a nephrostomy catheter, percutaneous, including a diagnostic nephrostogram and imaging guidance (fluoroscopy and/or ultrasound) — a catheter whose distal tip remains in the renal pelvis for external drainage. Code 50433 describes placement of a nephrostoureteral catheter, which extends from the renal pelvis through the ureter into the bladder, providing internal-external drainage — distinct from a nephrostomy catheter alone. Code 50435 describes exchange (replacement) of an existing nephrostomy catheter over a wire, not initial placement. Code 50393 describes introduction of a ureteral catheter or stent into the ureter through the renal pelvis, without the bundled imaging guidance that 50432 includes. The catheter type (nephrostomy vs. nephrostoureteral) and whether imaging guidance is included distinguish 50432 from the alternatives.

Question 13

A urologist treats a 1.0 cm renal calculus with extracorporeal shock wave lithotripsy. Which CPT® code is reported?

  1. 50060
  2. 50080
  3. 50081
  4. 50590 (correct answer)
Explanation: CPT® 50590 describes lithotripsy performed via extracorporeal shock wave (ESWL), in which externally generated acoustic shock waves are focused on the stone to fragment it without skin incision. Code 50060 describes open nephrolithotomy, which requires a surgical incision into the kidney. Code 50080 describes percutaneous nephrostolithotomy for a stone up to 2 cm — a percutaneous endoscopic approach through a nephrostomy tract. Code 50081 describes PCNL for stones over 2 cm. ESWL (50590) is the non-invasive option; PCNL (50080/50081) is minimally invasive percutaneous endoscopy; open nephrolithotomy (50060) is the most invasive. The treatment modality, not stone size alone, determines the correct code.

Question 14

A urologist performs an open total (simple) nephrectomy for a non-functioning kidney, without lymphadenectomy. Which CPT® code is reported?

  1. 50230
  2. 50220 (correct answer)
  3. 50240
  4. 50546
Explanation: CPT® 50220 describes nephrectomy including partial ureterectomy by any open approach — the correct code for total removal of a kidney without lymphadenectomy or vena caval thrombectomy. Code 50230 describes open radical nephrectomy with regional lymphadenectomy and/or vena caval thrombectomy; since no lymph node dissection is performed, 50230 is incorrect. Code 50240 describes partial nephrectomy, which preserves a portion of the kidney — the procedure here removes the entire kidney. Code 50546 describes laparoscopic (not open) simple nephrectomy. When only the kidney (and partial ureter) is removed via an open approach without oncologic lymph node dissection, 50220 is the correct code.

Question 15

A cystoscopy is performed with fulguration and resection of a medium bladder tumor measuring 3.0 cm. Which CPT® code is reported?

  1. 52234
  2. 52235 (correct answer)
  3. 52224
  4. 52240
Explanation: CPT® 52235 describes cystourethroscopy with fulguration and/or resection of a medium bladder tumor, defined as 2.0 to 5.0 cm — a 3.0 cm tumor falls within this range. Code 52234 describes resection of a small bladder tumor (0.5 cm up to 2.0 cm); this code should not be used for a tumor measuring 3.0 cm. Code 52224 describes fulguration of minor lesions less than 0.5 cm, with or without biopsy. Code 52240 describes resection of a large bladder tumor exceeding 5.0 cm. The three-tier size classification (small: 0.5 to <2 cm, medium: 2 to 5 cm, large: >5 cm) is the key axis for TURBT coding.

Question 16

A urologist performs a percutaneous nephrostolithotomy (PCNL) to remove a renal calculus measuring 2.4 cm. Which CPT® code is reported?

  1. 50060
  2. 50080
  3. 50081 (correct answer)
  4. 50590
Explanation: CPT® 50081 describes percutaneous nephrostolithotomy or pyelostolithotomy for a stone exceeding 2 cm — a 2.4 cm calculus is above the threshold and requires 50081. Code 50080 describes the same percutaneous approach for a stone up to and including 2 cm; the stone here is 2.4 cm, so 50080 is incorrect. Code 50060 describes open nephrolithotomy, which is an invasive surgical incision into the kidney rather than a percutaneous approach. Code 50590 describes extracorporeal shock wave lithotripsy (ESWL), a non-invasive fragmentation technique, not percutaneous endoscopic stone removal. The 2 cm size threshold is the single differentiator between 50080 and 50081.

Question 17

A urologist performs an open radical nephrectomy with regional lymphadenectomy for renal cell carcinoma. Which CPT® code is reported?

  1. 50230 (correct answer)
  2. 50220
  3. 50240
  4. 50545
Explanation: CPT® 50230 describes open radical nephrectomy including regional lymphadenectomy and/or vena caval thrombectomy — the appropriate code when the kidney is removed en bloc with surrounding lymph nodes, as performed for oncologic control of renal cell carcinoma. Code 50220 describes open simple (total) nephrectomy without lymphadenectomy, which would be appropriate for a benign condition requiring nephrectomy rather than a cancer requiring regional node dissection. Code 50240 describes partial nephrectomy, which preserves part of the kidney rather than removing it entirely. Code 50545 describes laparoscopic radical nephrectomy — the same oncologic extent but performed through a minimally invasive approach.

Question 18

A urologist performs a laparoscopic simple (total) nephrectomy for a non-functioning kidney due to chronic pyelonephritis. Which CPT® code is reported?

  1. 50220
  2. 50546 (correct answer)
  3. 50545
  4. 50543
Explanation: CPT® 50546 describes laparoscopic nephrectomy (simple, total removal of the kidney) via a minimally invasive approach. Code 50220 describes the same simple total nephrectomy performed through an open incision — the approach (laparoscopic vs. open) distinguishes 50546 from 50220. Code 50545 describes laparoscopic radical nephrectomy with lymphadenectomy, which is the oncologic procedure used for cancer rather than a simple nephrectomy for a benign non-functioning kidney. Code 50543 describes laparoscopic partial nephrectomy, which preserves a portion of the kidney rather than removing it entirely. The surgical approach (laparoscopic vs. open) and the extent of resection (partial vs. total vs. radical) together determine the correct nephrectomy code.

Question 19

A urologist performs a ureteroscopy with laser lithotripsy of a ureteral calculus and places an indwelling double-J ureteral stent at the conclusion. Which CPT® code is reported?

  1. 52352
  2. 52353
  3. 52356 (correct answer)
  4. 52355
Explanation: CPT® 52356 describes cystourethroscopy with ureteroscopy, with lithotripsy, including insertion of an indwelling ureteral stent — the correct code when both lithotripsy and stent placement are performed in the same session. Code 52353 describes ureteroscopy with lithotripsy when no stent is placed at the time of the procedure; upgrading to 52356 is required when a stent is inserted. Code 52352 describes ureteroscopy with removal or manipulation of a calculus without lithotripsy — stone retrieval by basket or forceps rather than laser fragmentation. Code 52355 describes ureteroscopy with resection of a ureteral or renal pelvic tumor, not a calculus procedure. The combination of lithotripsy plus stent insertion is the feature that selects 52356 over 52353.

Question 20

A cystoscopy is performed with resection of a large bladder tumor measuring 6.0 cm. Which CPT® code is reported?

  1. 52240 (correct answer)
  2. 52235
  3. 52234
  4. 52224
Explanation: CPT® 52240 describes cystourethroscopy with fulguration and/or resection of a large bladder tumor exceeding 5.0 cm — a 6.0 cm tumor exceeds this threshold and requires 52240. Code 52235 describes medium tumor resection (2.0 to 5.0 cm); the 6.0 cm tumor is above the medium range. Code 52234 describes small tumor resection (0.5 cm up to 2.0 cm). Code 52224 describes fulguration only of minor lesions less than 0.5 cm. The three size thresholds — 0.5 cm, 2.0 cm, and 5.0 cm — separate the four bladder tumor fulguration/resection codes, and using the wrong tier is a common coding error.