Question 1

A middle-age man needs to have a complete adrenalectomy with excision of an adjacent retroperitoneal tumor. His surgeon plans to use a transabdominal approach to perform this procedure and will take biopsies of the surrounding tissue.

Accepted Answer

60545 is the correct code for a partial or complete adrenalectomy with excision of an adjacent retroperitoneal tumor. This code can be used with or without biopsy. Surgery can be performed using multiple approaches including transabdominal, lumbar, or dorsal.
Code 60540 is incorrect because this procedure is not just for the adrenalectomy, it also needs to include the excision of the tumor. Codes 60650 and 60659 are incorrect because both of these codes are for laparoscopic procedures.

Question 2

A 52-year-old man has a chemodectoma (also known as a carotid body tumor) that is aggressive. It is recommended to have this removed. Because of how aggressive it is, the carotid artery is also excised. What CPT code should be used for this procedure?

Accepted Answer

60605 is the correct code for excision of both the carotid body tumor and the carotid artery.
Code 60600 is incorrect because this code is for just the excision of the carotid body tumor and does not involve excision of the carotid artery. Code 61703 is incorrect because this code is for surgery of intracranial aneurysm, including application of an occluding clamp to the carotid artery. Code 61705 is incorrect because this code is for an aneurysm surgery of a vascular malformation by intracranial and cervical occlusion of the carotid artery.

Question 3

A young boy has a carotid body tumor that was just discovered. It is a simple tumor at this time and is not very aggressive. No excision of the carotid artery will have to be performed with this tumor. What is the correct CPT code for this procedure?

Accepted Answer

60600 is the correct code for excision of carotid body tumor without excision of the carotid artery.
Code 60605 is incorrect because this code includes excision of the carotid artery. Codes 61703 and 61705 are both incorrect because these are codes for aneurysm surgeries involving carotid artery occlusion.

Question 4

A patient with a carotid body tumor and inflammation around the carotid body has had an ultrasound and MRI with imaging that indicates a larger amount of inflammation than normal in this area. His surgeon elects to undergo laparoscopy of this area to obtain more information before scheduling surgery to remove the tumor, to better prepare for whether the carotid artery will have to be excised as well. The patient is scheduled for surgical laparoscopy to explore the carotid body. What is the correct CPT code for this procedure?

Accepted Answer

60659 is the correct code for an unlisted laparoscopic procedure involving the endocrine system.
Code 60600 is incorrect because this code is for excision of the carotid body tumor without carotid artery excision. Code 60605 is incorrect because this code is for excision of both the carotid body tumor and the carotid artery. Code 60699 is incorrect because there is a specific "unlisted" laparoscopic procedure code for the endocrine system

Question 5

Surgeries of the skull base are often categorized according to three things. Which of the following includes the three things by which surgeries of the skull base are categorized?

Accepted Answer

Definitive procedure, approach procedure, and repair or reconstruction are the three things by which surgeries of the skull base are categorized. The approach procedure is the procedure that is done to gain access or exposure to the lesion or operation site. The definitive procedure is the actual biopsy, excision, or treatment of the lesion or operation site. The repair or reconstruction procedure is only reported separately if it is extensive or complicated, and it includes the closure of the surgical site such as skin grafts.

Question 6

PROCEDURAL NOTE PATIENT: Lopez, Olga
AGE: 76 years
DATE: 11/05/2014
PATIENT DIAGNOSIS: Multiple Skull Lymphoma
PROCEDURE: Craniotomy converted to craniectomy of left anterior cranial base
ANESTHESIA: General endotracheal
The patient was placed in supine position on operating table and anesthesia was successfully administered. The patient was prepped in the usual manner. An incision was made on the midline of the patient's anterior cranial base and the surgeon dissected the epidermal layer to reveal the skull. Three .2 to .4 cm lymphomas were located and the skull bone was excised in one piece to remove the affected are as leaving a .1 cm margin. Halfway through the procedure the patient's blood pressure dropped. It was difficult to control throughout the remaining procedure. Due to the patient's drop in blood pressure, the surgeon decided to convert the procedure to a craniectomy, so that bone grafts were not placed. A drain was placed beneath the remaining skull base and the edges of the skin were then sutured back together using 4-0 vicryl sutures. A sterile dressing was placed on the excision site. The patient was removed from endotracheal anesthesia and remained under physician supervision until her blood pressure stabilized. The patient was taken to the recovery room and scheduled for a bone graft at a later date. What is the correct code for this surgery?

Accepted Answer

The correct code for the surgery is 61500 (Craniotomy; with Excision of Tumor or Other Bone Lesion of Skull).Modifier -52 and -53 do not need to be used to indicate that it was a discontinued procedure because the procedure was completed. The original procedure, a craniotomy was converted to a modified procedure, a craniotomy. Code 61518 is also incorrect because it is used for a craniotomy, for the excision of brain tumor, rather than excision of bone lesion of skull.

Question 7

A physician performed craniotomy on a patient with a severe head trauma and intracerebral hematoma. Due to the patient's condition the procedure was extremely difficult, requiring a significant amount of extra time and effort. What is the correct code for this procedure?

Accepted Answer

The correct code for the procedure is 61313 (Craniectomy or Craniotomy for Evacuation of Hematoma, Supratentorial; Intracerebral) combined with modifier -22 to indicate that the procedure was an increased procedural service. Code 61315 is inappropriate because it is used for an infratentorial, intracerebellar hematoma.

Question 8

A physician utilized a laser and neuroendoscopic guidance to create a duct from the third lateral ventricle to the cisterna magna as a treatment for hydrocephalus. What is the correct code for this procedure?

Accepted Answer

The code for the procedure is 62201 (Ventriculocisternostomy, Third Ventricle; Sterotactic, Neuroendoscopic Method). Code 62200 is for the same procedure, but without using the neuroendoscope. Code 62180 is also for the same procedure, but it does not take into account the third ventricle. Code 62220 is used for the creation of a shunt, but in this case, a shunt was not created.

Question 9

A pediatrician performed a lumbar puncture on a 2-day-old premature infant weighing 2.3 kg with possible meningitis. What is the correct code for this service?

Accepted Answer

The correct code for this service is with 62270 (Spinal Puncture, Lumbar, Diagnostic) combined with modifier -63 to indicate that the patient weighed less than 4 kg. Code 62270 (Spinal Puncture, Therapeutic, for Drainage or Cerebrospinal Fluid) is incorrect because the lumbar puncture was performed to evaluate the spinal column fluid not treat the spinal column by performing the lumbar puncture.

Question 10

A 59-year-old patient with continuous post-traumatic pain received a tunneled epidural catheter for long-term pain medication administration by use of an external pump. The patient was previously implanted with an intrathecal pump, which was ineffective for the patient's pain management. Before the implantation of the epidural pump, the physician removed the intrathecal catheter. What are the correct CPT codes for this service?

Accepted Answer

The correct CPT codes for this service are 62350 (Implantation, Revision, or Repositioning of Tunneled, Intrathecal or Epidural Catheter, for Long-Term Medication Administration via an External Pump or Implantable Reservoir/Infusion Pump; without Laminectomy) and 62355 (Removal of Previously Implanted Intrathecal or Epidural Catheter). The removal of the intrathecal catheter needs to be coded separately with modifier -51, indicating that it was multiple procedures.

Question 11

A physician performed the excision of an intra spinal intra dural neoplasm of the sacral area. What is the correct code for this procedure?

Accepted Answer

The correct code for the procedure is 63283 (Laminectomy for Biopsy/Excision of Intra spinal Neoplasm; Intra dural, Sacral). Code 63275 is incorrect because it is used for an extradural, cervical lesion. Code 63273 is incorrect because it is used for the excision of a lesion other than a neoplasm, and code 63278 is incorrect because it is used for an extra dural, sacral lesion.

Question 12

A pediatric neurologist performed a repair of 3.4 cm meningocele on 40-day-old infant with spina bifida weighing 3 kg. Due to the location, size and depth of the meningocele, complex closure of 7 cm wound was required. What are the correct codes for this procedure?

Accepted Answer

The correct codes for this procedure are: 63700 (Repair of Meningocele; Less than 5 cm Diameter) and 13101 (Repair, Complex, Trunk; 2.6 cm to 7.5 cm). Code 63700 should not be appended with modifier -63 because the coder is specifically instructed not to append modifier -63 to the code in parenthesis under the code. Modifier -51 should be appended to 13101to indicate that it was multiple procedures.

Question 13

A young man has to have a lumbar spinal tap performed to obtain cerebrospinal fluid. This will be done with a needle for diagnostic purposes so that the fluid can be tested. What is the correct code for this procedure?

Accepted Answer

62270 is the correct code for a diagnostic lumbar spinal puncture.
Code 62269 is incorrect because this is the code for a biopsy of the spinal cord with a percutaneous needle. Code 62272 is incorrect because this is the code for a therapeutic spinal puncture for drainage of cerebrospinal fluid by needle or by catheter. Code 62273 is incorrect because this code is for the injection/epidural of blood or clot patch

Question 14

A patient needs to have a lumbar laminectomy without discectomy. Which code is correct for this procedure?

Accepted Answer

63005 is the correct code for lumbar laminectomy except when done for spondylolisthesis.
Code 63001 is incorrect because this code is for cervical laminectomy. Code 63003 is incorrect because this is for thoracic laminectomy and code 63011 is incorrect because it is for sacral laminectomy.

Question 15

A 40-year-old man needs to have a percutaneous implantation of a neurostimulator electrode array to the trigeminal nerve, which is a cranial nerve. What code is correct for this procedure?

Accepted Answer

64553 is the correct code for a percutaneous implantation of a cranial nerve neurostimulator electrode array.
Code 64550 is incorrect because this code is for the application of a surface or transcutaneous neurostimulator. Code 64555 is incorrect because this code is for a peripheral nerve and 64561 is incorrect because this code is used for the sacral nerve.

Question 16

A 62-year-old man needs to have a trigeminal nerve block to help with the pain caused by shingles. What CPT code should be used for this procedure?

Accepted Answer

64400 is the correct code for an aesthetic agent injection into the trigeminal nerve, also known as a trigeminal nerve block.
Code 64402 is incorrect because this code is for the injection of a facial nerve. Code 64405 is incorrect because this code is for the greater occipital nerve and 64408 is incorrect because this code is for the vagus nerve.

Question 17

During oral surgery, the lingual nerve was transected. What CPT code should be used for this transection?

Accepted Answer

64740 is the correct code for transection or avulsion of the lingual nerve.
Code 64732 is incorrect because this is the transection or avulsion of the supraorbital nerve. Code 64734 is incorrect because this code is for the infraorbital nerve and 64742 is incorrect because this code is for the transection or avulsion of the facial nerve.

Question 18

A 53-year-old woman has been having significant sciatica. She is going to have a neuroplasty of the sciatic nerve. What is the correct code for this procedure?

Accepted Answer

64712 is the correct code for a neuroplasty of the sciatic nerve.
Code 64702 is incorrect because this code is for a digital neuroplasty and 64704 is incorrect because this code is for a neuroplasty of a nerve in the hand or foot. Code 64708 is incorrect because this is for a neuroplasty of a major peripheral nerve of the arm or leg

Question 19

A 26-year-old man who had right ACL reconstruction surgery received a femoral nerve block. What CPT code should be used for the femoral nerve block?

Accepted Answer

64447 is the correct code for a single femoral nerve anesthetic agent injection, also known as a nerve block.
Code 64445 is incorrect because this code is for the sciatic nerve and code 64449 is incorrect because this code is for the lumbar plexus nerve. Code 64450 is incorrect because this is for "other" peripheral nerve or branch anesthetic agent injection.

Question 20

A patient needs to have an anesthetic agent injected into the superior hypogastric plexus nerve. What CPT code should be used for this procedure?

Accepted Answer

64517 is the correct code for anesthetic agent injection of the superior hypogastric plexus.
Code 64505 is incorrect because this injection is for the sphenopalatine ganglion. Code 64510 is incorrect because this code is for injection of the stellate ganglion. Code 64520 is incorrect because this code is for injection of the lumbar or thoracic nerves.

Quiz 2: Series