CPC Ch14- Endocrine System and Nervous System Review Questions

Question 1

The endocrine system is comprised of:
A. Nerves
B. Glands
C. Skeletal Parts
D. Tissue

Answer 1

B. Glands

Rationale: The endocrine system is comprised of glands, located throughout the body, that produce various hormones.

Question 2

The pancreas gland has what two functions?
A. Maintains calcium levels and to secrete hormones
B. Produces melatonin and adrenaline
C. Controls immune function and helps regulate breathing and blood pressure
D. Produces insulin and glucagon to regulate blood glucose levels and secretes digestive enzymes

Answer 2

D. Produces insulin and glucagon to regulate blood glucose levels and sectretes digestive enzymes

Rationale: The pancreas gland performs both endocrine and exocrine (digestive) functions. It produces several hormones (including insulin and glucagon) that regulate blood glucose levels. It also secretes digestive enzymes that flow via the pancreatic duct to the small intestine.

Question 3

Adrenal means:
A. Near the kidneys
B. Back of the thyroid
C. Near the stomach
D. Within the brain

Answer 3

A. Near the kidneys

Rationale: Adrenal means near the kidneys. The adrenal glands are above each kidney.

Question 4

What does it mean when a patient has a thymectomy performed by a sternal split approach?
A. Excision of thymus by cutting into the neck
B. Excision of the thyroid by cutting into the chest
C. Excision of the thymus by cutting into the chest
D. Excision of the isthmus by cutting into the neck

Answer 4

C. Excision of the thymus by cutting into the chest

Rationale: Thymectomy (partial or total) describes excision of the thymus. This may be achieved by several surgical approaches, including transcervical (via the neck), transthoracic, or sternal split (via chest).

Question 5

Which endocrine gland does not have lobes?
A. Thyroid
B. Pineal
C. Pituitary
D. Thymus

Answer 5

B. Pineal

Rationale: The pineal gland, found deep within the brain, looks like a pinecone, and is the size of a grain of rice. The thyroid, pituitary, and thymus have two lobes.

Question 6

The nervous system is composed of what two parts?
A. Central and Peripheral Nervous Systems
B. Sensory and Reflex Systems
C. Brain and Skeletal Muscles
D. Nerves and Neurons

Answer 6

A. Central and Peripheral Nervous System

Rationale: The nervous system is comprised of two parts: (1) Central Nervous System (CNS) which is the brain and spinal cord in command of the entire body movement and function. (2) Peripheral Nervous System (PNS) which incorporates all the nerves running throughout the body that sends information and receives instruction from the CNS.

Question 7

Which nerve is the largest nerve of the body?
A. Femoral
B. Intercostal
C. Radial
D. Sciatic

Answer 7

D. Sciatic

Rationale: The largest nerve of the body is the sciatic nerve which divides into the tibial and common fibular (common peroneal) nerves.

Question 8

What is not a region of the spinal cord nerve segments?
A. Lumbar
B. Cervical
C. Vertebra
D. Coccygeal

Answer 8

C. Vertebra

Rationale: Vertebra is not a region of the spinal nerve segments because it is the bony segment surrounding the spinal cord. The lumbar region has five segments forming five pairs of lumbar nerves. The cervical region has seven segments forming eight pairs of cervical nerves. The coccygeal region has three segments forming one pair of coccygeal nerves.

Question 9

What is a vertebral segment?
A. A single complete vertebral bone with its associated articular process and laminae
B. Non-bony compartment between two adjacent vertebral bodies
C. The lamina between the spinous and transverse process
D. Overlaps the vertebrae to give the spine the ability to bend and twist

Answer 9

A. A single complete vertebral bone with its associated articular process and laminae

Rationale: A vertebral segment describes the basic constituent part into which the spine may be divided. It represents a single complete vertebral bone with its associated articular process and laminae.

Question 10

What part of the brain is affected when one has a stroke and is unable to speak or write?
A. Frontal lobe
B. Cerebellum
C. Tempoal lobe
D. Parietal lobe

Answer 10

D. Parietal lobe

Rationale: The parietal lobes are at the top of the brain. The right lobe processes visuo-spatial information, while the left lobe processes spoken and written information. The frontal lobe stores how you use language and how you interpret language/speech. A person may have trouble understanding what other people are saying or understanding their own thoughts or feelings. The ability to speak and write takes place in the left parietal lobe.

Question 11

Select the code for a patient diagnosed with thyrotoxicosis crisis with an overactive nodular goiter.
A. E05.00
B. E05.10
C. E05.21
D. E05.20

Answer 11

C. E05.21

Rationale: The diagnosis is indexed under Thyrotoxicosis/with/goiter/nodular/with thyroid storm directing you to code E05.21. Verify code selection in the Tabular List.

Question 12

A 42-year-old male with thyroid cancer is admitted to the hospital for hypersecretion of calcitonin (functional activity) caused by the cancer. Choose the ICD-10-CM code(s) to report.
A. E07.0, C73
B. C73, E07.0
C. E07.0, Z85.850
D. E07.0

Answer 12

B. C73, E07.0

Rationale: When a patient has functional activity (thyrotoxicosis or disorders of thyrocalcitonin secretion) associated with a neoplasm, the neoplasm should be reported first, and the functional activity caused by the neoplasm is reported as a secondary code. There is no documentation of the patient having a history of other cancers, so a Z code is not appropriate. In the ICD-10-CM Alphabetic Index look for Carcinoma/thyroid; there is no listing in the Alphabetic Index. Use the instruction - see also Neoplasm, by site, malignant which is next to Carcinoma. In the Table of Neoplasms, look for Neoplasm, neoplastic/thyroid (gland)/Malignant Primary (column) directing you to code C73. In the Tabular List, C73 states to “Use additional code to identify any functional activity.” The second diagnosis code is in the Alphabetic Index under Hypersecretion/calcitonin directing you to code E07.0. Verify code selection in the Tabular List.

Question 13

A 65-year-old patient with type 1 diabetes may need left lower leg amputation due to diabetic gangrene. Select the ICD-10-CM code(s) to report.
A. E10.52
B. I96, E10.52
C. I96, E10.9
D. E11.52, I96

Answer 13

A. E10.52

Rationale: Type 1 diabetes with diabetic gangrene is found in the ICD-10-CM Alphabetic Index; look for Diabetes, diabetic/type 1/with/gangrene, directing you to E10.52. Code E10.52 is a combination code so a separate code for the gangrene is not reported. Verify code selection in the Tabular List.

Question 14

A 70-year-old patient has toxic myelitis due to inhaling vapors of carbon tetrachloride from using a fire extinguisher. The appropriate codes to report are:
A. G92.9, T59.4X1A
B. G92.9, T58.2X1A
C. T53.0X1A, G92.9
D. G92.9, T53.0X1A

Answer 14

C. T53.0X1A, G92.9

Rationale: Toxic myelitis is in the ICD-10-CM Alphabetic Index under Myelitis/toxic, directing you to code G92.9. Under G92.9 in the Tabular List, there is an instructional note to code first, if applicable, poisoning due to drug or toxin (T36-T65). In the Table of Drugs and Chemicals, look for Carbon/tetrachloride (vapor) NEC/Poisoning Accidental (unintentional) column guiding you to code T53.0X1-. Verification in the Tabular List indicates to add a 7th character; A is reported for the initial encounter. Code G92.9 is reported as a secondary code. Verify code selection in the Tabular List.

Question 15

A 27-year-old had an MVA accident a couple days ago and sees his primary care physician for pain management for acute pain in his neck since the accident. Select the ICD-10-CM code(s).
A. R52
B. G89.11, M54.2
C. M54.2, Z04.3
D. F45.41

Answer 15

B. G89.11, M54.2

Question 16

A 59-year-old female with failed back syndrome has undergone a recent test dose of intrathecal narcotics with good pain response. She is brought to the operating room for preparation and insertion of Medtronic programmable pain pump and intrathecal catheter. What CPT® codes are reported for this surgery?
A. 62360, 62350-51
B. 62362, 62324-51
C. 62361, 62324-51
D. 62362, 62350-51

Answer 16

D. 62362, 62350-51

Rationale: The patient is having an insertion of a programmable pump and an intrathecal catheter implanted to infuse pain meds for pain management. An infusion of pain medications is not performed. Look in the CPT® Index for Infusion Pump/Spinal Cord directing you to codes 62361-62362. Look in the CPT® Index for Catheterization/Spinal Cord, directing you to codes 62350-62351 for the second code. Look in the Nervous System section to select the correct code.

Question 17

A college student goes to the ER with symptoms of headache and high fever for the past two days. A lumbar puncture is performed, and spinal fluid is sent to the lab to check for meningitis. What CPT® code is reported for this surgery?
A. 62282
B. 62272
C. 62270
D. 62267

Answer 17

C. 62270

Rationale: The patient is not having an injection or an aspiration of contents found in the nucleus pulposus, intervertebral disc, or paravertebral tissue. The procedure is a spinal puncture in the lumbar area to determine if the patient has meningitis. Look in the CPT® Index for Spinal Puncture/Diagnostic/Lumbar. Verify the code in the Nervous System section.

Question 18

A 35-year-old male has a left chronic subdural hematoma. He will undergo a left burr hole evacuation of the one hematoma. What CPT® code is reported for this surgery?
A. 61108
B. 61154
C. 61156
D. 61105

Answer 18

B. 61154

Rationale: The keywords in this scenario are burr hole, evacuation, hematoma, and subdural. All of those words are found in the code description of procedure code 61154. Look in the CPT® Index for Burr Hole/for Drainage/Hematoma, guiding you to codes 61154-61156. Look in the Nervous System section to select the correct code.

Question 19

A patient has severe spinal stenosis between L3-L5 inferior to disc space. A laminectomy is performed on L4 along with a decompression of L3-L4 and L4-L5. What CPT® code is reported for this surgery?
A. 63005
B. 63012
C. 63020
D. 63047

Answer 19

A. 63005

Rationale: Only a laminectomy with decompression is performed. There is no documentation to indicate a facetectomy, foraminotomy, or discectomy was performed. Look in the CPT® Index for Laminectomy/for Decompression/Lumbar or Decompression/Spinal Cord. Verify code selection in the Nervous System section.

Question 20

A 50-year-old with left internal carotid artery stenosis presents for a left carotid thromboendarterectomy with electroencephalogram monitoring. Electroencephalogram (EEG) leads were placed on his head prior to surgery. Throughout the procedure, EEG patterns were symmetrical. Select the code for this EEG Monitoring. What CPT® code is reported?
A. 95954-26
B. 95957-26
C. 95955-26
D. 95958-26

Answer 20

C. 95955-26

Rationale: The physician is using an EEG to record and measure the patient’s brain electrical activity while performing the thromboendarterectomy (not intracranial surgery). Look in the CPT® Index for Electroencephalography/Intraoperative, guiding you to code 95955. Verify code selection in the Medicine section. Modifier 26 is added to report the physician’s professional component of the procedure.

Question 21

Select the HCPCS Level II code to report a patient having a spinal needle inserted into the nucleus pulposus of the L3/L4 intervertebral disc until the desired decompression is accomplished using radio frequency energy.
A. S2350
B. S2348
C. S9090
D. S2351

Answer 21

B. S2348

Rationale: Look in the HCPCS Level II Index for Decompression procedure, intervertebral disc, directing you to code S2348.

Question 22

A 45-year-old female has carpal tunnel syndrome. A neuroplasty is performed on her left wrist. During the surgery the patient’s blood pressure starts dropping and the surgeon decides to stop the operation. How should the procedure be reported?
A. 64721-52
B. 64721-53
C. 64721-54
D. No procedure is billed

Answer 22

B. 64721-53

Rationale: Modifier 53 is the appropriate modifier to append when the surgeon elects to terminate a surgical procedure due to the patient’s blood pressure dropping, which threatens the well-being of the patient.

Question 23

A neurosurgeon was called to the ER to examine a young child hit by a car. The neurosurgeon examines the patient with a diagnosis of a subdural hematoma and takes the child to the OR. Which modifier is appended to the Evaluation and Management service?
a. 22
B. 25
C. 57
D. 54

Answer 23

C. 57

Rationale: Modifier 57 is the appropriate modifier to append to the Evaluation and Management Service because the evaluation and examination of the child’s condition led the surgeon to make a decision for surgery. This surgical procedure is a major procedure with a 90-day global period. Modifier 25 is only appended to minor procedures which have a 0-10-day global period. Modifiers 22 and 54 are only appended to procedure codes, not Evaluation and Management services.

Question 24

A 6-week-old baby had a cerebrospinal fluid shunt placed two days ago. The shunt is not draining the excess CSF and the baby is returning to the OR for shunt removal and replacement by the same surgeon who placed the original shunt. What CPT® code is reported for this surgery?
A. 62258-79
B. 62256-58
C. 62258-78
D. 62230-76

Answer 24

C. 62258-78

Rationale: A complete removal of the cerebrospinal fluid shunt system with a replacement is performed. Look in the CPT® Index for Shunt/Brain/Removal, directing you to codes 62256-62258. Modifier 78 is the appropriate modifier to append for two reasons: (1) the patient returned to the operating room following the initial procedure during the postoperative period; (2) the same surgeon performed the initial procedure and the removal and replacement of the shunt.

Question 25

A patient sees her physician for follow up of a repaired damaged nerve to her finger. During the visit, she tells the doctor she fell and hit her little toe this morning; now it is red and swollen, and she wants to make sure it’s not broken. The physician examines the toe and reassures her it is not fractured. The doctor also examines the finger, which is healing well with no infection. Select the E/M service for this visit.
A. 99212-24
B. 99212-55
C. 99212-79
D. No service is billed since the patient is in the postoperative period

Answer 25

A. 99212-24

Rationale: Even though the patient is in a postoperative period from surgery, the physician can bill this E/M visit and append modifier 24. The examination is unrelated to the nerve repair surgery. Modifiers 55 and 54 are only appended to surgical procedure codes not Evaluation and Management services.

Question 26

What is the term for paralysis affecting one side of the body?
A. Paraplegia
B. Hemiplegia
C. Quadriplegia
D. Monoplegia

Answer 26

B. Hemiplegia

Rationale: Hemi is half. Hemiplegia is paralysis affecting one side of the body.

Question 27

Looking in the CPT® manual the Nervous System is divided into what subheadings?
A. Central Nervous System and Peripheral Nervous System
B. Skull, Meninges, and Brain; Spine and Spinal Cord; Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System.
C. Skull, Spine, Peripheral Nervous System, Central Nervous System
D. Brain, Central Nervous System, Autonomic Nervous System

Answer 27

B. Skull, Meninges, and Brain; Spine and Spinal Cord; Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System.

Rationale: CPT® divides the nervous system into three primary subheadings:
1. Skull, Meninges, and Brain (61000–62258)
2. Spine and Spinal Cord (62263–63746)
3. Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System (64400–64999)

Question 28

What specificity is added to Alzheimer’s disease in ICD-10-CM?
A. The onset of Alzheimer’s disease.
B. Visual disturbances associated with Alzheimer’s disease.
C. Neurological manifestations of Alzheimer’s disease.
D. The stage of Alzheimer’s disease.

Answer 28

A. The onset of Alzheimer’s disease.

Rationale: In ICD-10-CM the codes for Alzheimer’s disease are expanded to specify early or late onset, other or unspecified.

Question 29

What ICD-10-CM code is reported for Addisonian crisis?
A. E27.2
B. E27.0
C. E27.40
D. E27.1

Answer 29

A. E27.2

Rationale: Look in the ICD-10-CM Alphabetic Index for Crisis/Addisonian directing you to E27.2. Verify code selection in the Tabular List.

Question 30

What disease is characterized by enlarged skeletal parts?
A. Acromegaly
B. Cushing’s Syndrome
C. Goiter
D. Hyperthyroidism

Answer 30

A. Acromegaly

Rationale: Acromegaly is characterized by enlarged skeletal parts, especially the nose, ears, jaws, fingers and toes. It is caused by hypersecretion of growth hormone (GH) from the pituitary gland.

Question 31

How is Streptococcal A Meningitis reported in ICD-10-CM?
A. Streptococcal, group A, as the cause of diseases classified elsewhere is reported first; Streptococcal meningitis is reported second.
B. Only Streptococcal, group A, as the cause of diseases classified elsewhere is reported.
C. Streptococcal meningitis is reported first; Streptococcal, group A, as the cause of diseases classified elsewhere is reported second.
D. Only one code is reported for streptococcal meningitis.

Answer 31

C. Streptococcal meningitis is reported first; Streptococcal, group A, as the cause of diseases classified elsewhere is reported second.

Rationale: Look in the ICD-10-CM Alphabetic Index for Meningitis/streptococcal (acute) directing the coder to G00.2. In the Tabular List, G00.2 has a note to use an additional code to further identify the organism. The organism is Streptococcus A. In the Alphabetic Index, look for Streptococcus, streptococcal/group/A, as cause of disease classified elsewhere directing the coder to B95.0. Verify all codes in the Tabular List.

Question 32

A patient is having a decompression of the nerve root involving two segments of the lumbar spine via transpedicular approach. What CPT® code(s) is/are reported?
A. 63056
B. 63056, 63057
C. 63030
D. 63030, 63035

Answer 32

B. 63056, 63057

Question 33

What ICD-10-CM code is reported for Ataxia telangiectasia?
A. G11.3
B. G31.89
C. R27.0
D. G11.0

Answer 33

A. G11.3

Question 34

The provider removes the thymus gland in a 27-year-old female with myasthenia gravis. Using a transcervical approach the blood supply to the thymus is divided and the thymus is dissected free from the pericardium and the thymus is removed. What CPT® code is reported for this procedure?
A. 60522
B. 60540
C. 60520
D. 60521

Answer 34

C. 60520

Rationale: Excision of the thymus gland is a thymectomy and is coded based on the approach. Code 60520 is for a transcervical approach, as documented. In the CPT® Index look for Thymectomy/Transcervical Approach.

Question 35

A patient has a total thyroidectomy to remove thyroid cancer. Removal of all the lymph nodes along with the spinal accessory nerve, jugular vein and sternocleidomastoid muscles are performed to remove a malignant lymphatic chain. What CPT® and ICD-10-CM codes are reported?
A. 60254, C73
B. 60252, C32.3
C. 60220, C32.3
D. 60210, C73

Answer 35

A. 60254, C73

Rationale: In the CPT® Index look for Thyroidectomy/Total/for Malignancy/Radical Neck Dissection directing you to 60254. A radical neck dissection includes removal of all lymph nodes.
In the ICD-10-CM Table of Neoplasms look for Neoplasm, neoplastic/thyroid (gland) and select from the Malignant Primary column directing you to C73. Verification in the Tabular List confirms code selection.

Question 36

A provider is performing an experimental cervical sympathectomy on a patient with Raynaud’s Syndrome. What CPT® and ICD-10-CM codes are reported?
A. 64802-50, I73.00
B. 64804-50, I73.01
C. 64802, I73.00
D. 64804, I73.01

Answer 36

C. 64802, I73.00

Rationale: In the CPT® Index look for Sympathectomy/Cervical, directing you to code 64802. There is no mention of this being a bilateral procedure, so modifier 50 is not warranted.

In ICD-10-CM Alphabetic Index, look for Raynaud’s disease, phenomenon or syndrome and you are directed to I73.00. There is no mention of gangrene so you will not report I73.01. Verification in the Tabular List confirms code selection.

Question 37

What ICD-10-CM code is used for hemiplegia affecting the left dominant side?
A. G83.32
B. G81.92
C. R20.2
D. G82.21

Answer 37

B. G81.92

Rationale: In the ICD-10-CM Alphabetic Index, look for Hemiplegia directing you to G81.9-. In the Tabular List a 5th character is required to complete the code. The 5th character of 2 indicates it affects the left dominant side.

Question 38

What ICD-10-CM code is used for intractable grand mal seizures without status epilepticus?
A. G40.909
B. R56.9
C. G40.419
D. I67.89

Answer 38

C. G40.419

Rationale: In the ICD-10-CM Alphabetic Index look for Grand mal directing you to see Epilepsy, generalized, specified NEC. Look for Epilepsy/generalized/specified NEC/intractable/without status epilepticus or look for Seizure(s)/grand mal/intractable/without status epilepticus directing you to G40.419. Verification in the Tabular List confirms code selection.

Question 39

Under general anesthesia the provider excises the lower 1/3 portion of the right lobe of the thyroid as well as the 2/3 of the left lobe. The isthmus is also removed. What CPT® code(s) is/are reported?
A. 60210-LT, 60210-RT
B. 60210, 60212
C. 60225-50
D. 60212

Answer 39

D. 60212

Rationale: In the CPT® Index look for Thyroidectomy/Partial, directing you to code range 60210-60225. 60212 reports surgical removal of a part of one lobe of the thyroid gland and most of the portion of the other lobe of the thyroid gland. The provider also performs surgical removal of the isthmus, the tissue connecting the two lobes of the thyroid gland in the middle.

Question 40

A patient has a right thyroid lobectomy for a thyroid follicular lesion. An incision is made 2 cm above the sternal notch and carried through the platysma. The right thyroid was dissected free from the surrounding tissues. The isthmus was divided from the left thyroid lobe. The left thyroid lobe was explored revealing a single nodule. The right thyroid lobe was completely removed from the trachea and surrounding tissues. It was marked and sent off the table as a specimen. What CPT® code is reported?
A. 60200
B. 60220
C. 60210
D. 60240

Answer 40

B. 60220

Rationale: The patient had a unilateral thyroidectomy. Because only the right side is removed, it is a total unilateral (partial) thyroidectomy. In the CPT® Index look for Thyroidectomy/Partial directing you to code range 60210-60225. 60220 reports a unilateral total thyroid lobectomy with or without isthmusectomy.

Question 41

A 41-year-old female has carpal tunnel syndrome in her left hand. The patient underwent release of the carpal ligament with internal neurolysis. An incision was made directly over the carpal ligament through the skin to the carpal ligament. Under direct vision the carpal ligament was divided then internal neurolysis of the median nerve was performed using a magnifying loupes. What CPT® code is reported?
A. 64721-LT
B. 64704-LT
C. 64722-LT
D. 64719-LT

Answer 41

A. 64721-LT

Rationale: In the CPT® Index look for Carpal Tunnel Syndrome/Decompression. 64721 is the correct code because it is the median nerve being stretched (neurolysis) to relieve the pain in the wrist for a person with carpal tunnel syndrome.

Question 42

A patient with a malignant neoplasm of the spinal meninges is receiving a programmable pump implantation for chemotherapy. The patient is placed in the prone position where the provider made a midline incision overlying the area of the spinal cord. The reservoir was placed in the subcutaneous tissues and attached to the previously placed catheter. Layered sutures were used to close the incision. The patient tolerated the procedure well and was released in good condition. What CPT® and ICD-10-CM codes are reported for this procedure?
A. 62362, C70.1
B. 62360, C70.0
C. 62367, C70.1
D. 62350, C70.0

Answer 42

A. 62362, C70.1

Question 43

Operative Report
PROCEDURE: Left L3-L4 peri-articular paravertebral facet joint injection.
PATIENT HISTORY: The patient is a 67-year-old woman referred by Dr. X for repeat diagnostic/therapeutic spinal injection procedure. She is about 1 1/2 years status post lumbar decompression for stenosis. Two weeks ago she underwent an interarticular left L4-L5 paravertebral facet joint injection. She had no relief of symptoms from that injection.
TECHNIQUE: The patient was positioned prone and the skin was prepped and draped in the usual sterile fashion. The skin and underlying soft tissues were anesthetized with 3 cc of 1% lidocaine. Due to the advanced degenerative changes, the left L3-L4 paravertebral facet joint could not be distinctly visualized fluoroscopically, despite trying numerous angles. This was explained to the patient who wished to proceed with the injection. A 22-gauge 6-inch spinal needle was advanced toward the region of the left L3-L4 paravertebral facet joint under fluoroscopic guidance. Injection of 0.5 cc of Isovue 200 contrast showed the needle was not in an intravascular location.
Intra-articular placement could not be confirmed and the injection was presumed to be peri-articular. 2 cc containing equal parts preservative free 2% Lidocaine plus Depo-Medrol (80 mg per ml) was injected. The patient reported injection of medication produced discomfort in the region of her usual left low back pain. Immediately following the procedure, upon standing up from the procedure table, she reported her pain was a little bit better.
What CPT® code(s) is/are reported for this procedure?
A. 64493-50-26
B. 64493-26
C. 64493
D. 64493-50, 77003

Answer 43

C. 64493

Rationale: Nerve block injections are selected based on location and number of levels. Code 64493 is described as a paravertebral facet joint of lumbar spine, single level. The injection was only on the left and not performed bilaterally. This code descriptor includes imaging guidance, and it is not reported separately. In the CPT® Index look for Injection/Paravertebral Facet Joint/Nerve/with image guidance.

Question 44

A patient with primary hyperparathyroidism undergoes parathyroid sestamibi (nuclear medicine scan) and ultrasound and is found to have only one diseased parathyroid. A minimally invasive parathyroidectomy is performed. What CPT® and ICD-10-CM codes are reported for the surgery?
A. 60502, E21.3
B. 60500, E21.3
C. 60500, E21.0
D. 60505, E21.0

Answer 44

C. 60500, E21.0

Question 45

A 59-year-old is suffering from foraminal spinal stenosis. Patient is to have a L4-L5 laminectomy on the right side. Under general anesthesia a knife dissection was made on the back and was taken down to the fascia. The fascia on the right side of the spine was stripped. The deep Taylor retractor was placed. Using an intraoperative X-ray, the physician traced out the foramen of L4-L5. There appeared to be some compression at this lamina into the foramen and significant stenosis. The provider removed the spinous process and lamina. Nerve roots canals are freed by removal of the facet. Compression is relieved by removing bony overgrowth around the foramen. What CPT® code is reported for this procedure?
A. 63047
B. 63017
C. 63030
D. 63005

Answer 45

A. 63047

Rationale: In the CPT® Index look for Laminectomy/with Facetectomy directing you to 63045-63048, 0202T, 0274T, 0275T. A laminectomy with knife dissection is being performed for spinal stenosis eliminating codes 0202T, 0274T, and 0275T. Codes 63045-63048 are reported based on location. This was performed on the lumbar, making the correct code 63047. 63030 is a code specific to the interspaces and codes 63001 and 63017 specifically state without facetectomy making them incorrect choices.

Question 46

A 47-year-old male presents with chronic back pain and lower left leg radiculitis. A laminectomy is performed on the inferior end of L5. The microscope is used to perform microdissection. There was a large extradural cystic structure on the right side underneath the nerve root as well as the left. The entire intraspinal lesion was evacuated. What CPT® code(s) is/are reported for this procedure?
A. 63272
B. 63277
C. 63252, 69990
D. 63267, 69990

Answer 46

D. 63267, 69990

Rationale: In the CPT® Index look for Laminectomy/for Excision/Intraspinal Lesion/Other than Neoplasm directing you to code range 63265-63268 and 63270-63273. The code range is divided based on whether the lesion is extradural or intradural. In this case, it is extradural narrowing the range to 63265-63268. The range is further divided based on the location of the spine the lesion is located. Laminectomy with evacuation of an intraspinal lesion in the lumbar spine is described by code 63267. The use of a microscope is documented to perform microdissection. In the CPT® Index look for Operating Microscope directing you to 69990.

Question 47

A 37-year-old has multilevel lumbar degenerative disc disease and is coming in for an epidural injection. Localizing the skin over the area of L5-S1, the provider uses the transforaminal approach with fluoroscopy. The spinal needle is inserted and the patient experienced paresthesia in her left lower extremities. The anesthetic drug is injected into the epidural space. What CPT® code(s) is/are reported for this procedure?
A. 64483
B. 64483, 64484
C. 64493
D. 64493, 64494

Answer 47

A. 64483

Rationale: In the CPT® Index look for Epidural/Injection/Transforaminal. Review the codes to choose appropriate service. 64483 is the correct code since the anesthetic was injected into the epidural space in a single level (L5-S1) with the transforaminal approach.

Question 48

A patient recently experienced muscle atrophy and noticed she did not have pain when she cut herself on a piece of glass. The provider decides to obtain a needle biopsy of the spinal cord under ultrasound guidance in the outpatient setting. The biopsy results come back as syringomyelia. What CPT® and ICD-10-CM codes are reported for the biopsy procedure?
A. 62269, G12.9
B. 62269, 76942-26, G95.0
C. 62270, G12.9
D. 62270, 76942-26, G95.0

Answer 48

B. 62269, 76942-26, G95.0

Rationale: In the CPT® Index look for Biopsy/Spinal Cord/Percutaneous and you are directed to code 62269. Instructional note under code 62269 indicates for radiological supervision and interpretation, see 76942, 77002, and 77012. Ultrasound guidance for needle placement, 76942, can be separately billed. Modifier 26 is appended for the professional services.

In the ICD-10-CM Alphabetic Index look for Syringomyelia directing you to code G95.0. Verification in the Tabular List confirms code selection.

Question 49

A 55-year-old man presents with uncontrolled tremors that have become quite severe and are now disabling. A trial of a deep brain stimulator electrode is recommended. The patient is placed in the head holder adapter for the frame. The scalp is incised exposing the skull using a perforator to make a single burr hole 2.5 cm from the midline at the level of the coronal suture exposing the dura and is punctured for access. Microelectrode recording (MER) and stimulation is done to target and reposition the electrodes to determine the best placement for the neurostimulator electrode. The neurostimulator electrode array is placed in the thalamus and fastened into position with radiographic image monitoring placement. The lead is coiled in a pocket under the galea, which is sutured closed, followed by skin closure. What CPT® code is reported?
A. 61863
B. 61850
C. 61868
D. 61867

Answer 49

D. 61867

Question 50

A 26-year-old patient presents with headache, neck pain and fever and is concerned he may have meningitis. The patient was placed in the sitting position and given 0.5 mg Ativan IV. His back was prepped and a 20-gauge needle punctured the spine between L4 and L5 with the return of clear fluid. The cerebrospinal fluid was reviewed and showed no sign of meningitis. What CPT® code is reported?
A. 62270
B. 62282
C. 62272
D. 62326

Answer 50

A. 62270

Rationale: In the CPT® Index look for Puncture/Spinal Cord/Diagnostic or Spinal Tap/Lumbar. 62270 is the correct code because a spinal puncture was performed without fluoroscopic or CT guidance in the lumbar region (L4 and L5). It was done to withdraw cerebrospinal fluid for testing to determine if the patient had meningitis (diagnostic).