1.

An infant born at 33 weeks underwent five photocoagulation treatments to both eyes due to
retinopathy of prematurity at six months of age. The physician used an operating microscope during
these procedures. These treatments occurred once per day for a defined treatment period of five days.
How would you report all of these services?
a. 67229 -50
b. 67229 x 5
c. 67229, 69990
d. 67229

2. Todd had a tumor removed from his left temporal bone. How would you report this service?
a. 61563
b. 61500
c. 69979, 69990-51
d. 69970

3. Jennifer was admitted to the hospital for an aspiration of two thyroid cysts. Her physician completed
this procedure with CT guidance of the needle including interpretation and report. How would you
report the professional services?
a. 60300-26, 76942-26
b. 60300 x 2, 77012-26
c. 10021, 60300-51, 77012-26
d. 60300

4. Baby Smith was diagnosed with meningitis. His physician placed a needle through the fontanel at the
suture line to obtain a spinal fluid sample on Monday. The needle was withdrawn and the area
bandaged. The baby required another subdural tap bilaterally on Wednesday. How would you report
Wednesday’s service?
a. 61001
b. 61000, 61001
c. 61070
d. 61001-50

6. Dr. Martin performed an excision at the middle cranial fossa for a vascular lesion. This procedure was
completed in an intradural fashion with dural repair and graft. His partner, Dr. Sutter, performed an
infratemporal approach with decompression of the auditory canal. How should Dr. Martin report her
services?
a. 61590, 61606-51
b. 61606-62
c. 61606
d. 61601

7. After a snow skiing accident, Barry had a cervical laminoplasty to four vertebral segments. How should
you report this procedure?
a. 63050 x 4
b. 22600, 63051-51
c. 22842, 63045, 63050
d. 63050
8. How is a neuroplasty procedure described in the CPT Professional Edition?
a. The decompression or freeing of intact nerve from scar tissue, including external neurolysis and/or
transposition
b. The surgical repair of nerves using only microscopic techniques
c. The position of nerves tested one or more anatomic digits
d. The decompression or freeing of an intact vein from scar tissue, including external neurolysis and/or
transposition

9. Phyllis fell down on the ice and fractured her leg. The fall also caused severe injury to the muscles and
tore several nerves. Her physician completed suturing of two major peripheral nerves in her leg without
transposition and shortened the bone. After the surgery she was seen by a physical therapist for
ongoing treatment and gait training. How would you report the surgical procedure?
a. 64857, 64859-51, 64876-51
b. 64856, 64857
c. 64857, 64859, 64876
d. 64858, 64857, 64859, 64876

10. John was hospitalized for a repair of a laceration to his left conjunctiva by mobilization and
rearrangement. How should you report this procedure?
a. 65273-LT
b. 67930
c. 65272
d. 67930-LT
11. The patient is a 64-year-old female who is undergoing a removal of a previously implanted
Medtronic pain pump and catheter due to a possible infection. The back was incised; dissection was
carried down to the previously placed catheter. There was evidence of infection with some fat necrosis
in which cultures were taken. The intrathecal portion of the catheter was removed. Next the pump
pocket was opened with evidence of seroma. The pump was dissected from the anterior fascia. A 7-mm
Blake drain was placed in the pump pocket through a stab incision and secured to the skin with
interrupted Prolene. The pump pocket was copiously irrigated with saline and closed in two layers. What
are the CPT and ICD-9-CM codes for this procedure?

A. 62365, 62350-51, 996.75, V53.09 B. 62360, 62355, 998.51

C. 62365, 62355-51, 996.63 D. 36590, 996.75, 998.13

12. The patient is a 73-year-old gentleman who was noted to have progressive gait instability over the
past several months. Magnetic resonance imaging demonstrated a ventriculomegaly. It was
recommended that the patient proceed forward with right frontal ventriculoperitoneal shunt placement
with Codman programmable valve. What is the correct code for this surgery?

A. 62220 B. 62223 C. 62190 D. 62192

13. What is the CPT code for the decompression of the median nerve found in the space in the wrist on
the palmar side?

A. 64704 B. 64713 C. 64721 D. 64719

14. 2-year-old Hispanic male has a chalazion on both upper and lower lid of the right eye. He was placed
under general anesthesia. With an #11 blade the chalazion was incised and a small curette was then
used to retrieve any granulomatous material on both lids. What code should be used for this procedure?

A. 67801 B. 67805 C. 67800 D. 67808

15. MRI reveals patient has cervical stenosis. It was determined he should undergo bilateral cervical
laminectomy at C3 through C6 and fusion. The edges of the laminectomy were then cleaned up with a
Kerrison and foraminotomies were done at C4, C5, and,,C6. The stenosis is central: a facetectomy is
performed by using a burr. Nerve root canals were freed by additional resection of the facet, and
compression of the spinal cord was relieved by removal of a tissue overgrowth around the foramen.
Which CPT codes should be used for this procedure?
A. 63045-50, 63048-50
B. 63020-50, 63035-50, 63035-50
C. 63015-50
D. 63045, 63048 x 3

16. An extracapsular cataract removal is performed on the right eye by manually using an iris expansion
device to expand the pupil. A phacomulsicfication unit was used to remove the nucleus and irrigation
and aspiration was used to remove the residual cortex allowing the insertion of the intraocular lens.
What code should be used for this procedure?
A. 66985
B. 66984
C. 66982
D. 66983

17. An infant who has chronic otitis media was placed under general anesthesia and a radial incision was
made in the posterior quadrant of the left tympanic membrane. A large amount of mucoid effusion was
suctioned and then a ventilating tube was placed in both ears. What CPT and ICD-9-CM codes should be
reported:
A. 69436-50, 381.20
B. 69436-50, 381.4
C. 69433-50, 381.02
D. 69421-50, 381.20
18. A craniectomy is being performed on a patient who has Chiari malformation. Once the posterior
inferior scalp was removed a C-1 and a partial C-2 laminectomy was then performed. The right
cerebellar tonsil was dissected free of the dorsal medulla and a gush of cerebrospinal fluid gave good
decompression of the posterior fossa content. Which CPT code should be used?
A. 61322
B. 61345
C. 61343
D. 61458

19. Under fluoroscopic guidance an injection of a combination of steroid and analgesic agent is
performed on T2-T3, T4-T5, T6-T7 and T8-T9 on the left side into the paravertebral facet joints. The
procedure was performed for pain due to thoracic root lesions. What are the procedure codes?
A. 64479, 64480x3, 77003
B. 64490, 64491, 64492x2, 77003
C. 64520x4, 77003
D. 64490, 64491, 64492

20. An entropian repair is performed on the left lower eyelid in which undermining was performed with
scissors of the inferior lid and inferior temporal region. Deep sutures were used to separate the eyelid
margin outwardly along with stripping the lateral tarsus to provide firm approximation of the lower lid
to the globe. The correct CPT code is:
A. 67914-E4
B. 67924-E2
C. 67921-E2
D. 67917-E1
21. The patient was taken to the procedure room and placed prone and the L4–L5 interspace was
identified using fluoroscopy to determine the injection site. The patient was prepped in routine sterile
fashion with Betadine and covered in sterile drape. 1% lidocaine was used to anesthetize the skin,
subcutaneous tissue, and muscle. Once the proper anesthesia was obtained, a 3 inch, 20 gauge Tuohy
needle was inserted and slowly advanced towards the L4-L5 interspace. Using a 6 cc glass syringe and
the loss-of-resistance technique the epidural space was identified. After aspiration revealed no blood or
cerebrospinal fluid return, the syringes were then changed and 80 mg/ml preservative-free Depo
Medrol and 2 cc of 1% methylparaben free lidocaine were injected in slow incremental fashion. After
aspiration, all needles were removed intact, the skin was cleaned and a Band-Aid was applied. Code this
encounter.
A. 62311 B. 62311, 77003-26
C. 62310, 77003-26 D. 62319, 77003-26

22. A 65-year-old patient presented with ectropion of the right lower eyelid. Repair with tarsal wedge
excision is performed for correction. Attention was then directed to the left eye. The patient also had an
ectropion of the left lower lid which was repaired by suture repair. Code this procedure.
A. 67916-50 B. 67916-E4, 67914-E2
C. 67914-50 D. 67923-E4, 67921-E2

23. A 42-year-old patient returns to the hospital neurology clinic for follow-up. He was checked three
days prior to this visit where a lumbar puncture was done to find the etology of the patient’s headaches.
The headaches have increased in intensity over the past three days. The neurologist examines the
patient and finds a CSF leak from the lumbar puncture. A blood patch by epidural injection is performed
to repair the leak. Code the services for today’s visit.
A. 62272 B. 62273
C. 62270, 62273 D. 62270, 62287
24. A 63-year-old woman presented to the eye clinic as a new patient with symptoms of flashing lights
and floaters in the right eye for two days duration. The ophthalmologist does a general evaluation of the
complete visual system, including dilating her eyes and checking her with the indirect ophthalmoscope,
revealing peripheral retinal tear. The physician explains to the patient that if left untreated, there is a
high likelihood of retinal detachment. The patient agrees to the procedure. The physician lasers the
retinal tear and tells the patient to come back in 24 hours for follow-up. Code this visit.
A. 67210, 92004-25 B. 67145, 92004-25
C. 66821 D. 67145
25. What is the full CPT® code description for 61535?
A. Craniotomy with elevation of bone flap; for subdural implantation of an electrode array, for long-term
seizure monitoring; for removal of epidural or subdural electrode array, without excision of cerebral
tissue (separate procedure)
B. Craniotomy with elevation of bone flap; for removal of epidural or subdural electrode array, without
excision of cerebral tissue (separate procedure)
C. For removal of epidural or subdural electrode array, without excision of cerebral tissue (separate
procedure)
D. For excision of epileptogenic focus without electrocorticography during surgery; ; for removal of
epidural or subdural electrode array, without excision of cerebral tissue (separate procedure)
26. Postoperative Diagnosis: Carpal tunnel syndrome right wrist The patient was brought to the
operating room and sedated by anesthesia. After sterile prepping and draping of the right hand, wrist
and arm the patient’s area of incision was infiltrated with Xylocaine/Marcaine infiltration. After
satisfactory anesthesia an Esmarch bandage was used to exsanguinate the right hand and wrist and used
about the distal forearm as a tourniquet. A curvilinear incision was made on the palmar aspect of the
right wrist. Dissection was carried out through the skin and subcutaneous tissue. Bleeding was
controlled. The median nerve and it branches were identified, retracted, and protected at all times. The
ligament was incised from proximal to distal. A thorough decompression was carried out. A neurolysis
was carried out. The nerve was found to be flattened and ischemic underneath the transverse carpal
ligament. The fascia was closed, the tourniquet was released. A dressing was applied and patient was
transferred to recovery room. Code this procedure.
A. 64721-RT B. 64450-RT
C. 64614-RT D. 29848-RT

27. A 35-year-old man presents to the urgent care center with severe neck pain. The physician examines
the patient and makes the diagnosis of cervical nerve impingement and injects an anesthetic agent into
the cervical plexus using three injections. Select the procedure and diagnosis codes.
A. 64400 x 3 B. 64405
C. 64413 D. 64413 x 3

28. A four-year-old with chronic otitis media and fluid buildup in both ears was admitted by her
otolaryngologist for a bilateral tympanostomy. The procedure was performed with placement of
ventilating tubes. The procedure required general anesthetic due to the patient’s age. Select the
procedure code for this procedure.
A. 69420-50 B. 69421-50
C. 69433-50 D. 69436-50
29. A patient presents to the emergency department with complaint of painful eye. The patient states
that her right eye is constantly tearing and is sensitive to light. The physician performs an exam and
identifies a corneal foreign body in the right eye. Utilizing a slit lamp, the foreign body is removed. Code
the encounter.
A. 65205-RT B. 65220-RT
C. 65222-RT D. 65435-RT

30. The physician performs a right thyroid lobectomy. The patient was prepped and draped. After
adequate general anesthesia, the neck was incised on the right side and sharp dissection was then used
to cut down onto the strap muscles and sternodcleidomastoid muscles. The strap muscles were
separated and transected on the right side. A small thyroid lobe was visualized and dissected free. There
was no evidence of a tumor. The wound was closed with 3-0 interrupted Vicryl for the platysma, 4-0
Vicryl for the deep tissues and 6-0 fast absorbing gut for the skin. Code the encounter.
A. 60252-RT B. 60210-RT
C. 60220-RT D. 60260-RT
31. PROCEDURE: Bilateral lumbar medial branch block under fluoroscopy for the L3, L4, L5 medial
branches for the L4-L5, L5-S/1 facets for diagnostic and therapeutic purposes. PROCEDURE: The patient
was placed in the prone position on the fluoroscopy table and automated blood pressure cuff and pulse
oximeter applied. The skin entry points for approaching the anatomic target points of the bilateral
segmental medial branches or dorsal ramus of L3, L4, L5 were identified with a 22.5 degree from
perpendicular lateral oblique fluoroscopy view and marked. Following thorough Chloraprep preparation
of the skin and draping and 1% lidocaine infiltration of the skin entry points and subcutaneous tissues, a
22 gauge 6" spinal needle was placed under fluoroscopic guidance down on the target point for each
respective segmental medial branch or dorsal ramus. At each point 1 mL consisting of 0.5% bupivacaine
and Depo-Medrol was injected. A total of 80 mg of Depo-Medrol was divided between all six spots. Code
the procedure(s).
A. 64483, 64484, 77003-26 B. 64493-50, 64494-50, 64495-50
C. 64493, 64494, 63395 x 4, 77003-26 D. 64493-50, 64494-50
32. A 43-year-old patient who suffers from severe intermittent vertigo has been definitively diagnosed
with Meniere’s disease. After a year of various treatments, medications, tests, and behavior/lifestyle
changes that have failed to lessen the symptoms, she now presents for a transcanal chemical
labyrinthotomy to the right ear. Dr. Miller visualizes the tympanic membrane with an operating
microscope, cleans the ear canal, and makes a small incision into the tympanic membrane. Gentamicin is
delivered into the right ear. The patient is repositioned with the right ear up and monitored by the
nurse. The perfusion is repeated to achieve the maximum result. The ear is suctioned, cleaned, and
carefully examined for bleeding. The patient tolerated the procedure well and is returned to the
recovery area in satisfactory condition. How would Dr. Miller report his professional services?
a. 386.04, 69801 x 2, 69990-51
b. 386.04, 69905 x 2, 69990-51
c. 386.00, 69801, 69990
d. 386.00, 69905, 69990
33. What code(s) would be reported for the following case?
Preoperative diagnosis: Bilateral impacted ventilating tube
Postoperative diagnosis: Same
Anesthesia: General
Procedure performed: Removal and replacement of new tubes, bilaterally via tympanostomy
Procedure: Sammie, a 16-year-old patient, was admitted and taken to the operative suite and placed
under general anesthesia by inhalation. When adequate sedation was achieved, a 3.8-mm speculum was
inserted into the left ear, wax removed, and speculum removed. The impacted tube was then removed.
A new site was achieved within the same tympanosclerotic plaque and a new tube placed. The same
procedure was repeated to the right ear. Sammie was sent to the recovery suite in stable condition.
a. 69424-50, 69436-50
b. 69433-50
c. 69436-50
d. 69424-50, 69433-50
34. James returned two weeks after surgery, as planned, for a change in his drug delivery system. Today
Dr. Harvey opened the previous incision site. The previously placed reservoir was removed and a new
programmable subcutaneous pump was connected to the catheter and secured with sutures, tested,
and programmed. The subcutaneous incision was closed in layers with a sterile dressing placed. The
patient tolerated the procedure well. How should Dr. Harvey report this service?
a. 62362-58
b. 62365, 62362-59
c. 62350-58
d. 62350, 62355-59
35. Dr. Adams completed an anterior discectomy with decompression including osteophytectomy to
levels C3–C5.During the same session, he stabilized C3–C5 with anterior cervical interbody fusion. For
proper visualization, Dr. Adams used an operating microscope during all phases of the procedure.How
should Dr. Adams report this procedure?
a. 63075, 63078-51, 22551, 22554 x 2, 69990-51
b. 63075, 63078-51, 22551 x 2, 69990-51
c. 63075, 63076, 22554 x 2
d. 63075, 63076, 22551, 22552
36. With which code set or individual codes can add-on code 61781 be correctly reported?
a. 61720–61791
b. 62201 or 77432
c. 77371–77373
d. None of the above
37. Carl, a 28-year-old patient, has a history of epilepsy with recurrent seizures. His seizures are
intolerable even with medication management. He does not experience non-epileptic seizures, which
was confirmed by EEG recordings. Today he underwent an open procedure for implantation of cranial
nerve neurostimulator electrode array, which was coiled around the vagus nerve. The pulse generator
was connected to the neurostimulator array, tested, and repositioned to ensure maximum
effectiveness. The pulse generator was placed and sutured into a created subcutaneous pocket. Again,
the system is tested to ensure proper functionality. The subcutaneous tissues and skin are closed with
deep sutures and skin staples. Carl tolerated the procedure well and was returned to the recovery suite
in stable condition. Which code(s) should be reported for today’s services?
a. 61885, 64568-59
b. 64568
c. 61531
d. 64570, 61888-59, 64568-59
38. A 6-month-old patient required a bilateral subdural tap through a suture. How would this initial
procedure be reported?
a. 61000
b. 61001-63
c. 61000-50
d. 61020-63, 61000-50
39. A patient with Bell’s palsy is unable to squint, blink, or close her left eyelid. To protect the eye, Dr.
Risser completes a temporary tarsorrhaphy with a Frost suture technique. How would you report this
procedure?
a. 67875-LT
b. 67710-LT
c. 67840-LT
d. 67950-LT
40. What code(s) should be reported with the following case?
Preoperative diagnosis: Total retinal detachment, right eye
Postoperative diagnosis: Same
Procedure performed: Complex repair of retinal detachment with photocoagulation, scleral buckle,
sclerotomy/vitrectomy
Anesthesia: Local
Procedure: The patient was placed, prepped, and draped in the usual manner. Adequate local
anesthesia was administered.
The operating microscope was used to visualize the retina, which has fallen into the posterior cavity. The
vitreous was extracted using a VISC to complete the posterior sclerotomy. Minimal scar tissue was
removed to release tension from the choroid. The retina was repositioned and attached using
photocoagulation laser, a gas bubble, and a suture placement of a scleral buckle around the eye. The
positioning of the retina was checked during the procedure to ensure proper alignment. Antibiotic
ointment was applied to the eye prior to placement of a pressure patch. The patient tolerated the
procedure well and returned to the recovery suite in satisfactory condition.
a. 361.05, 67113-RT, 67107-51, 67145-51, 66990-51
b. 361.05, 67113-RT, 69990-RT
c. 361.00, 67113-RT, 66990-RT
d. 361.00, 67113-RT, 67107-51, 67145-51, 66990-51
41. A patient had a bilateral strabismus surgery involving the medial and lateral rectus muscles. The
surgeon explored and repaired a detached extraocular muscle in the right eye and placed bilateral
posterior fixation sutures with muscle recession. How should you report this procedure?
a. 67316-50, 67332-RT, 67334-50
b. 67316-50, 67332-RT, 67335-50
c. 67312-50, 67340-RT, 67334-50
d. 67312-50, 67340-RT, 67335-50

60000 part 2

____ 1. A patient with chronic lumbago is seen by the provider to have an epidural injection of a
non-neurolytic substance at the sacral level. What CPT® code is reported for this procedure?
a. 62320 c. 62326
b. 62360 d. 62322

____ 2. What is the ICD-10-CM code for a cavernous hemangioma in intracranial structures?
a. D18.00 c. D18.03
b. D18.02 d. Q82.5

____ 3. 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. 60520 c. 60522
b. 60521 d. 60540

____ 4. What ICD-10-CM code is used for intractable grand mal seizures without status
epilepticus?
a. R56.9 c. G40.909
b. I67.89 d. G40.419
____ 5. A patient is receiving pain management treatment for chronic cervical pain caused by a
motor vehicle accident. What ICD-10-CM code(s) and sequencing is/are reported?
a. G89.21, M54.2 c. G89.21
b. M54.2 d. M54.2, G89.21

____ 6. Under general anesthesia the provider excises the lower 1/3 portion of the right lobe of
the thyroid as well as the lower 1/3 of the left lobe. The isthmus is also removed. What CPT® code(s)
is/are reported?
a. 60210, 60212 c. 60210-LT, 60210-RT
b. 60225-50 d. 60212

____ 7. A 50 year-old male is diagnosed with a tumor of the skull base just below the occipital
tonsils. The neurosurgeon performs a transpetrosal approach to the posterior cranial fossa. He then
performs an intradural removal of the tumor of the posterior cranial fossa at the base of the skull. Dural
repair is done and the area is closed with Neurolon. What CPT® code(s) is/are reported?
a. 61521 c. 61598, 61616-51
b. 61524 d. 61597, 61616-51

____ 8. 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 c. 60220
b. 60210 d. 60240

____ 9. What ICD-10-CM code is used for hemiplegia affecting the left dominant side?
a. R20.2 c. G82.21
b. G81.92 d. G83.32

____ 10. What CPT® code is reported for a subtotal thyroidectomy for malignancy, with removal
of only a few selected lymph nodes?
a. 60271 c. 60240
b. 60260 d. 60252

____ 11. 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 c. 63030, 63035
b. 63056, 63057 d. 63030
____ 12. What diagnosis code is used for spinal meningitis?
a. A39.9 c. G04.90
b. G03.9 d. A87.9

____ 13. 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 c. 60220, C32.3
b. 60252, C32.3 d. 60210, C73

____14.A patient with MEN1 (Multiple Endocrine Neoplasia 1) has surgery to remove three of her
parathyroid glands and part of the fourth parathyroid gland. What CPT® and ICD-10-CM codes are
reported?
a. 60500, E31.21 c. 60502, E31.22
b. 60505, E31.21 d. 60505, E31.22

____ 15. A patient with a status post (after or following) lumbar puncture headache receives an
epidural blood patch. The patient’s venous blood is injected into the lumbar epidural space; this blood
forms a clot sealing the leak of CSF from the lumbar puncture. What CPT® and ICD-10-CM codes are
reported?
a. 62282, G97.1 c. 62273, G97.1
b. 62281, G44.1 d. 62273, G44.1

____ 16. What ICD-10-CM code is reported for Ataxia telangiectasia?

a. R27.0 c. G11.0
b. G31.89 d. G11.3

____ 17. 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, I73.00 c. 64804, I73.01
b. 64802-50, I73.00 d. 64804-50, I73.01

____ 18. What CPT® code is used to report neurorrhaphy with autogenous vein graft for one
nerve?
a. 64885 c. 64910
b. 64892 d. 64911

____ 19. A patient with a neoplasm of the spinal meninges has a programmable pump implanted
for chemotherapy administration. What CPT® and ICD-10-CM codes are reported?
a. 62361, C70.1 c. 96522, C41.2
b. 62362, C70.1 d. 62360, C41.2
____ 20. A patient with a herniated cervical disc undergoes a cervical laminotomy with a partial
facetectomy and excision of the herniated disc at cervical interspace C3-C4. What CPT® and ICD-10-CM
codes are reported?
a. 63050, M50.21 c. 63020, 63035, M50.91
b. 63020, M50.21 d. 63050, M50.91

____ 21. A patient with a right side, benign adrenal adenoma has a laparoscopic adrenalectomy.
What CPT® and ICD-10-CM codes are reported?
a. 50545, D35.01 c. 60540, C47.9
b. 60650, D35.01 d. 60545, C47.9

____ 22. Mrs. Marsden slipped on the ice last winter and fractured several lumbar vertebrae.
Since then she has required pain management therapy at her local hospital with an anesthesiologist. He
performs a therapeutic injection of 5% Marcaine mixed with the steroid Decadron (16mg) into the nerve
located in the facet joints at levels L3-L4 and L4-L5 on both sides at each level. What CPT® code(s) are
reported for this procedure?
a. 64493 x 2 c. 64493–50 x 4
b. 64493–50, 64494–50 d. 64483–50, 64484–50

____ 23. 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 c. 64493-50, 77003
b. 64493-26 d. 64493

____24.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. 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, 64484 c. 64493, 64494
b. 64493 d. 64483

____25.A 36 year-old male suffered back pain after heavy lifting and was found to have bilateral disc
herniation. The patient was placed prone and general anesthesia given. Incision was then made with a
10-blade knife and dissection was carried downward through the thick adipose tissue to the fascia in a
subperiosteal plane. The paraspinous muscles were reflected off L5 and S1. A laminotomy was drilled
with the Midas Tex AMB on the inferior end of L5. The thecal sac was retracted medially. The
microscope was brought in, direct with microdissection there was a massive disk herniation on the right
side underneath the nerve root as well as the left. The disc was incised with an 11-blade knife and was
cleaned out with a series of straight and angled curettes and rongeurs. The disc was intertwined with
the posterior longitudinal ligament. The space was cleaned out, the foramina were checked and no
further compression was found on any of the neural elements. What CPT® codes are reported for this
procedure?
a. 63047-50, 69990 c. 63030-50, 63035-50, 69990
b. 63030-50, 69990 d. 63005-50, 69990

____ 26 Postoperative Diagnosis: Carpal tunnel syndrome right wrist

The patient was brought to the operating room and sedated with anesthesia. After sterile prepping and
draping of the right hand, wrist and arm, the patient’s area of incision was infiltrated with
xylocaine/Marcaine infiltration. An Esmarch bandage was used to exsanguinate the right hand and wrist
and used about the distal forearm as a tourniquet. A curvilinear incision was made on the palmar aspect
of the right wrist. Dissection was carried out through the skin and subcutaneous tissue. Bleeding was
controlled. The median nerve and its branches were identified, retracted and protected at all times. The
ligament was incised from proximal to distal. A thorough decompression was carried out. A neurolysis
was carried out. The nerve was found to be flattened and ischemic underneath the transverse carpal
ligament. The fascia was closed and the tourniquet was released. A dressing was applied and the patient
was transferred to recovery room. What CPT® code is reported?
a. 64721-RT c. 29848-LT
b. 64721-LT d. 29848-RT

____ 27. A patient receives a paravertebral facet joint injection at three levels on both sides of
the lumbar spine using fluoroscopic guidance for lumbalgia. What CPT® and ICD-10-CM codes are
reported?
a. 64493, 64494 x 2, M54.41
b. 64493-50, 64494-50, 64495-50, M54.5
c. 64493, 64495 x 2, M54.41
d. 64495-50, M54.5

____ 28. PROCEDURES PERFORMED:

1. Bilateral facet joint injections, L4-L5
2. Bilateral facet joint injections, L5-S1.
3. Fluoroscopy.
TECHNIQUE: The AP view was aligned with the proper tilt so that the end plates for the desired levels
were perpendicular. The AP image showed the sacrum and the L5 spinous process. Manual palpation
located the sacral hiatus. The 6 inch, 20 gauge needle with a slight volar bend was inserted using
fluoroscopic into each facet joint under AP image. The bilateral L4-L5, and L5-S1 facet joints were
injected in a systematic fashion from caudal to cranial. A sterile dressing was applied. The patient
tolerated the procedure well with no complications and was transferred to recovery in good condition.
What CPT® codes are reported?
a. 64493-50, 64494-50, 77002-26 c. 64493-50, 64494-50
b. 64493-50 x 2 d. 64493-50, 64494-50-51, 77002-26

____ 29. A 47 year-old female presents to the OR for a partial corpectomy to three thoracic
vertebrae. One surgeon performs the transthoracic approach while another surgeon performs the three
vertebral nerve root decompressions necessary. How should each provider involved code their portion
of the surgery?
a. 63087-52, 63088-52 x 2 c. 63087-80, 63088-80 x 2
b. 63085-62, 63086-62 x 2 d. 63085, 63086-82 x 2

____ 30. A 15 year-old is taken to surgery for crushing his index and middle fingers and injuring
his digital nerves. The provider located the damaged nerves in both fingers and sutures them to restore
sensory function. What CPT® codes are reported?
a. 64831, 64872 c. 64831, 64837-51
b. 64834, 64837-51 d. 64831, 64832

____ 31. A patient with McCune-Albright syndrome has a fibrous tissue neoplasm of the frontal
bone (skull of cranium) extending into the orbit on the left. The surgeon excises the fibrous tissue
neoplasm off the bone and down through the dura mater. Prophylactic decompression of the optic
nerve was also performed. What CPT® and ICD-10-CM codes are reported?
a. 61519, D32.9 c. 61563, D22.9
b. 61564, Q78.1 d. 61512, Q68.8

____ 32. A patient is diagnosed with an injury to the right side facial nerve. In the OR suite the
surgeon performs a neurorrhaphy with nerve graft to restore innervation to the face using microscopic
repair. The surgeon created a 2 cm incision over the damaged nerve, dissected the tissues and located
the nerve. The damaged nerve was resected and removed. The 3.0 cm graft taken from the sural nerve
was sutured to the proximal and distal ends of the damaged nerve. What CPT® and ICD-10-CM codes are
reported?
a. 64885, S16.8XXA c. 64886, 69990, S16.8XXA
b. 64886, S04.51XD d. 64885, 69990, S04.51XA

____ 33. 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. 63267, 69990 c. 63272
b. 63252, 69990 d. 63277

____ 34. 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. 60500, E21.3 c. 60505, E21.0
b. 60502, E21.3 d. 60500, E21.0

35. 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. 62270, G12.9 c. 62269, G12.9
b. 62270, 76942-26, G95.0d. 62269, 76942-26, G95.0

____ 36. 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. 64704 c. 64721
b. 64719 d. 64722

____ 37. 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 c. 62282
b. 62272 d. 62326

____ 38. 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. 61850 c. 61867
b. 61863 d. 61870

____ 39. 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. 62350, C70.0 c. 62360, C70.0
b. 62362, C70.1 d. 62367, C70.1

____ 40. 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. 63005 c. 63047
b. 63017 d. 63030