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Chapter 14 Test Review Question 1_ 4 out of 4 points Looking in the CPT® manual the Nervous System is divided into what subheadings? Selected Answer: a. Skull, Meninges, and Brain; Spine and Spinal Cord; Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System. Correct Answer: a. Skull, Meninges, and Brain; Spine and Spinal Cord; Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System. Response Feedback: Rationale: CPT® divides the nervous system into three primary subheadings:
- Skull, Meninges, and Brain (61000–62258)
- Spine and Spinal Cord (62263–63746)
- Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System (64400–
Question 2_ 4 out of 4 points What is the term for uncontrolled muscle movements? Selected Answer: (^) b. Dyskinesia Correct Answer: (^) b. Dyskinesia Response Feedback: Rationale: Dyskinesia is the term for uncontrolled muscle movements. Question 3_ 4 out of 4 points When coding for surgery performed on the Skull Base (61580-61598) what term describes the method used to gain exposure to the lesion? Selected Answer: (^) a. Approach procedure Correct Answer: a. Approach procedure Response Feedback: Rationale: The approach procedure is the method used to access the lesion. The approach procedure to the skull base is reported using codes 61580-61598. In the CPT® Index look for Skull Base Surgery and you will see that many of the subterms indicate Approach, with a code range of 61580-61598. Question 4_ 4 out of 4 points
What is a parathyroidectomy? Selected Answer: (^) d. Removal of glands on the posterior surface of the thyroid. Correct Answer: (^) d. Removal of glands on the posterior surface of the thyroid. Response Feedback: Rationale: The parathyroid glands are four glands embedded on the posterior surface of the thyroid. A parathyroidectomy is the removal of a parathyroid gland or glands. Question 5_ 4 out of 4 points What are the four lobes of the brain? Selected Answer: (^) b. Frontal, Parietal, Temporal, Occipital Correct Answer: (^) b. Frontal, Parietal, Temporal, Occipital Response Feedback: Rationale: The four lobes of the brain are the Frontal Lobe, Parietal Lobe, Temporal Lobe, and Occipital Lobe. Question 6_ 4 out of 4 points What ICD-10-CM code is used for intractable grand mal seizures without status epilepticus? Selected Answer: (^) a. G40. Correct Answer: (^) a. G40. Response Feedback: Rationale: In the ICD-10-CM Alphabetic Index look for Grand mal and you are directed 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 7_ 4 out of 4 points 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? Selected Answer: (^) c. 61598, 61616- Correct Answer: (^) c. 61598, 61616-
Correct Answer: (^) d. 60212 Response Feedback: Rationale: In the CPT® Index look for Thyroidectomy/Partial (only the lower 1/3 of the right and left sides are excised). You are directed to code range 60210-60225. 60212 reports a partial Thyroidectomy for both sides and includes the removal of the isthmus. Question 11_ 4 out of 4 points What CPT® code is used to report neurorrhaphy with autogenous vein graft for one nerve? Selected Answer: (^) d. 64911 Correct Answer: d. 64911 Response Feedback: Rationale: A neurorrhaphy is a repair of the nerve that has been divided. In the CPT® Index look for Repair/Nerve/Graft which directs you to code range 64885-64911. 64911 is reported for a neurorrhaphy with autogenous vein graft. Question 12_ 4 out of 4 points A patient has a programmable pump implanted for chemotherapy administration. She has a neoplasm of the spinal meninges. What CPT® and ICD-10-CM codes are reported? Selected Answer: (^) a. 62362, C70. Correct Answer: (^) a. 62362, C70. Response Feedback: Rationale: In the CPT® Index look for Insertion/Infusion Pump/Spinal Cord and you are directed to code range 62361-62362. This is a programmable pump making 62362 the correct code selection. In ICD-10-CM Table of Neoplasms look for Neoplasm, neoplastic/spine, spinal (column)/meninges and select from the Malignant Primary column which directs you to C70.1. Verification in the Tabular List confirms code selection. Question 13_ 4 out of 4 points What ICD-10-CM code is reported for Ataxia telangiectasia? Selected Answer: (^) a. G11. Correct Answer: (^) a. G11. Response Feedback: Rationale: In the ICD-10-CM Alphabetic Index, look for Ataxia/telangiectasia which directs you to code G11.3. Verification in the Tabular List confirms code selection. Question 14_ 4 out of 4 points
What CPT® code is reported for a subtotal thyroidectomy for malignancy, with removal of only a few selected lymph nodes? Selected Answer: (^) c. 60252 Correct Answer: c. 60252 Response Feedback: Rationale: The removal of all of the lymph nodes of the neck during a thyroidectomy is considered a radical neck dissection. When limited removal of all of the lymph nodes of the neck is performed, it is reported with 60252. The thyroidectomy is performed due to the patient having a malignancy. In the CPT® Index look for Thyroidectomy/Total/for Malignancy/Limited Neck Dissection. Question 15_ 0 out of 4 points 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? Selected Answer: (^) b. M54.2, G89. Correct Answer: (^) a. G89.21, M54. Response Feedback: Rationale: In the ICD-10-CM Alphabetic Index look for Pain(s)/chronic/due to trauma and you are directed to G89.21. Cervical pain is found by looking in the Alphabetic Index for Pain(s)/neck NEC which directs you to M54.2. According to the ICD-10-CM guideline I.C.6.b.(b).(ii) when the treatment is for pain management, the chronic pain is listed first. Question 16_ 4 out of 4 points 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? Selected Answer: (^) d. 62270 Correct Answer: (^) d. 62270 Response Feedback: 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 in the lumbar region (L and L5). It was done to withdraw cerebrospinal fluid for testing to determine if the patient had meningitis (diagnostic). Question 17_ 4 out of 4 points A patient is diagnosed with an injury to the right side facial nerve. In the OR suite the surgeon performs a
the galea, which is sutured closed, followed by skin closure. What CPT® code is reported? Selected Answer: (^) c. 61867 Correct Answer: (^) c. 61867 Response Feedback: Rationale: In the CPT® Index look for Neurostimulators/Implantation/Electrode Array/by Craniectomy directing you to 61863-61864, 61867-61868. Code 61867 is the correct code to report the neurostimulator electrode placed in the subcortical site (thalamus) by going through a burr hole using microelectrode recording. Question 20_ 4 out of 4 points 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? Selected Answer: (^) d. 60500, E21. Correct Answer: d. 60500, E21. Response Feedback: Rationale: In the CPT® Index look for Parathyroidectomy or Parathyroid Gland/Excision and you are directed to code range 60500-60505. The parathyroidectomy is coded with 60500. 60502 is a re-exploration and 60505 is used for a mediastinal exploration or transthoracic approach. In the ICD-10-CM Alphabetic Index look for Hyperparathyroidism/primary and you are directed to E21.0. Verification in the Tabular list confirms code selection. Question 21_ 4 out of 4 points 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? Selected Answer: (^) b. 61564, Q78. Correct Answer: (^) b. 61564, Q78. Response Feedback: Rationale: The frontal bone is part of the cranium. In the CPT® Index look for Excision/Cranial Bone/Tumor and you are directed to code range 61563-61564. Because decompression of the optic nerve was also performed, 61564 is the correct code. In the ICD-10-CM Alphabetic Index, look for McCune-Albright syndrome which directs you to Q78.1. Verification in the Tabular List confirms code selection. Question 22_ 4 out of 4 points
A patient who has 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? Selected Answer: (^) b. 62362, C70. Correct Answer: (^) b. 62362, C70. Response Feedback: Rationale: The procedure performed is implanting a programmable pump which allows the infusion of a medication (e.g., chemotherapy) for treatment. For insertion or implantation of the pump, in the CPT® Index look for Infusion Pump/Spinal Cord guiding you to codes 62361-
- This is a programmable pump making 62362 the correct code selection. In ICD-10-CM Table of Neoplasms look for Neoplasm, neoplastic/spine, spinal (column)/meninges and select from the Malignant Primary column which directs you to C70.1. Verification in the Tabular List confirms code selection. Question 23_ 4 out of 4 points 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? Selected Answer: (^) c. 64493 Correct Answer: (^) c. 64493 Response Feedback: Rationale: Nerve block injections are selected based on location. Code 64493 is described as a paravertebral facet joint of lumbar spine, single level. 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.
(Additional Submission) Question 1_ 4 out of 4 points What disease is characterized by enlarged skeletal parts? Selected Answer: (^) d. Acromegaly Correct Answer: (^) d. Acromegaly Response Feedback: 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 2_ 4 out of 4 points Looking in the CPT® manual the Nervous System is divided into what subheadings? Selected Answer: b. Skull, Meninges, and Brain; Spine and Spinal Cord; Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System. Correct Answer: b. Skull, Meninges, and Brain; Spine and Spinal Cord; Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System. Response Feedback: Rationale: CPT® divides the nervous system into three primary subheadings:
- Skull, Meninges, and Brain (61000–62258)
- Spine and Spinal Cord (62263–63746)
- Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System (64400–
Question 3_ 4 out of 4 points What is a dime sized opening in the skull to access the brain called? Selected Answer: (^) b. Burr hole Correct Answer: (^) b. Burr hole Response Feedback: Rationale: A Burr hole is a dime sized opening in the skull, also called a keyhole craniotomy. Question 4_ 4 out of 4 points What is the term for uncontrolled muscle movements? Selected Answer: b.
Dyskinesia Correct Answer: b. Dyskinesia Response Feedback: Rationale: Dyskinesia is the term for uncontrolled muscle movements. Question 5_ 4 out of 4 points In ICD-10-CM which statement is TRUE regarding type I diabetes with peripheral angiopathy with gangrene? Selected Answer: c. One code is used to report diabetes with peripheral angiopathy; the gangrene is not reported separately. Correct Answer: c. One code is used to report diabetes with peripheral angiopathy; the gangrene is not reported separately. Response Feedback: Rationale: Look in the ICD-10-CM Alphabetic Index for Diabetes, diabetic/type 1/with peripheral angiopathy/with gangrene which directs you to E10.52. Verify code selection in the Tabular List. Question 6_ 4 out of 4 points What ICD-10-CM code is reported for Ataxia telangiectasia? Selected Answer: (^) d. G11. Correct Answer: (^) d. G11. Response Feedback: Rationale: In the ICD-10-CM Alphabetic Index, look for Ataxia/telangiectasia which directs you to code G11.3. Verification in the Tabular List confirms code selection. Question 7_ 4 out of 4 points What diagnosis code is used for spinal meningitis? Selected Answer: (^) a. G03. Correct Answer: (^) a. G03. Response Feedback: Rationale: In the ICD-10-CM Alphabetic Index, look for Meningitis. Spinal is a nonessential modifier and you are directed to G03.9. Verification in the Tabular List confirms code selection. Question 8_ 4 out of 4 points
Selected Answer: (^) d. D18. Correct Answer: (^) d. D18. Response Feedback: Rationale: In the ICD-10-CM Alphabetic Index look for Hemangioma/cavernous/intracranial which directs you to D18.02. Verification in the Tabular List confirms code selection. Question 12_ 4 out of 4 points What ICD-10-CM code is used for intractable grand mal seizures without status epilepticus? Selected Answer: (^) d. G40. Correct Answer: d. G40. Response Feedback: Rationale: In the ICD-10-CM Alphabetic Index look for Grand mal and you are directed 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 13_ 4 out of 4 points What CPT® code is reported for a subtotal thyroidectomy for malignancy, with removal of only a few selected lymph nodes? Selected Answer: c. 60252 Correct Answer: (^) c. 60252 Response Feedback: Rationale: The removal of all of the lymph nodes of the neck during a thyroidectomy is considered a radical neck dissection. When limited removal of all of the lymph nodes of the neck is performed, it is reported with 60252. The thyroidectomy is performed due to the patient having a malignancy. In the CPT® Index look for Thyroidectomy/Total/for Malignancy/Limited Neck Dissection. Question 14_ 4 out of 4 points 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? Selected Answer: (^) a. 60500, E31. Correct Answer: (^) a. 60500, E31.
Response Feedback: Rationale: in the CPT® Index look for Parathyroid/Excision directs you to 60500-60502. In the ICD-10-CM Alphabetic Index look for Neoplasia/endocrine, multiple (MEN)/type 1 directing you to E31.21. MEN is multiple endocrine neoplasia. This is also known as Wermer’s Syndrome and also indexes to E31.21. Verification in the Tabular List confirms code selection. Question 15_ 4 out of 4 points 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? Selected Answer: (^) d. 61598, 61616- Correct Answer: (^) d. 61598, 61616- Response Feedback: Rationale: You are coding for both the approach and definitive procedures for the skull base surgery. In the CPT® Index look for Skull Base Surgery/Posterior Cranial Fossa/Transpetrosal Approach which directs you to 61598 and Skull Base Surgery/Posterior Cranial Fossa/Intradural which directs you to code 61616 which includes the repair. Modifier 51 is added to indicate the same surgeon performed more than one procedure. Question 16_ 4 out of 4 points 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? Selected Answer: (^) c. 61564, Q78. Correct Answer: (^) c. 61564, Q78. Response Feedback: Rationale: The frontal bone is part of the cranium. In the CPT® Index look for Excision/Cranial Bone/Tumor and you are directed to code range 61563-61564. Because decompression of the optic nerve was also performed, 61564 is the correct code. In the ICD-10-CM Alphabetic Index, look for McCune-Albright syndrome which directs you to Q78.1. Verification in the Tabular List confirms code selection. Question 17_ 4 out of 4 points 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?
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? Selected Answer: (^) c. 64493 Correct Answer: (^) c. 64493 Response Feedback: Rationale: Nerve block injections are selected based on location. Code 64493 is described as a paravertebral facet joint of lumbar spine, single level. 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 20_ 4 out of 4 points 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? Selected Answer: (^) b. 64493-50, 64494-50, 64495-50, M54. Correct Answer: (^) b. 64493-50, 64494-50, 64495-50, M54. Response Feedback: Rationale: In the CPT® Index, look for Injection/Paravertebral Facet Joint/Nerve with Image Guidance and you are directed to 64490-64495. Code selection is based on the section of the spine (lumbar) and the levels injected. Modifier 50 is appended since it is bilateral. In the ICD- 10-CM Alphabetic Index look for Pain/lumbar region and you are directed to M54.5. Verification in the Tabular List confirms code selection. Question 21_ 4 out of 4 points A patient with a right side, benign adrenal adenoma has a laparoscopic adrenalectomy. What CPT® and ICD-10- CM codes are reported? Selected Answer: (^) d. 60650, D35. Correct Answer: (^) d. 60650, D35. Response Feedback: Rationale: In the CPT® Index look under Adrenalectomy/Laparoscopic and you are directed to
- 50545 is for a Radical Nephrectomy which includes an adrenalectomy. If you look for Adrenal Gland/Excision/Laparoscopy you are directed to 60650 which is the correct code choice. In the ICD-10-CM Table of Neoplasms look for Neoplasm, neoplastic/adrenal and select from the Benign column and you are directed to D35.0-. In the Tabular List the 5th^ character selection determines laterality, reporting 1 for the right side. Question 22_ 4 out of 4 points
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? Selected Answer: (^) c. 63267, 69990 Correct Answer: (^) c. 63267, 69990 Response Feedback: Rationale: In the CPT® Index look for Laminectomy/for Excision/Intraspinal Lesion/Other than Neoplasm and you are directed 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 and 63270-63273. The range is further divided based on the section 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 which directs you to 69990. Question 23_ 4 out of 4 points 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? Selected Answer: (^) b. 60500, E21. Correct Answer: (^) b. 60500, E21. Response Feedback: Rationale: In the CPT® Index look for Parathyroidectomy or Parathyroid Gland/Excision and you are directed to code range 60500-60505. The parathyroidectomy is coded with 60500. 60502 is a re-exploration and 60505 is used for a mediastinal exploration or transthoracic approach. In the ICD-10-CM Alphabetic Index look for Hyperparathyroidism/primary and you are directed to E21.0. Verification in the Tabular list confirms code selection. Question 24_ 4 out of 4 points 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? Selected Answer: (^) d. 63085-62, 63086-62 x 2 Correct Answer: (^) d. 63085-62, 63086-62 x 2 Response Feedback: Rationale: Two co-surgeons performed distinct parts of the same surgery. The surgery performed is a vertebral corpectomy, thoracic. Look in the CPT® Index for Vertebral/Corpectomy and you are directed to code range 63081-63103, 63300-63308. 63300-63308 are for excision of
