*Week 5: Nervous

If The Dr Didn't Say It Didn't Happen

Code What You See

Study Smarter Not Harder

Keep It Simple

Overthinking Is Not Ok

100

1. What does contralateral mean? a. Affecting or originating in the opposite side. b. Pertaining to the same side of the body. c. Lateral contractions. d. Contractions occurring on opposite sides of the body.

100

11. A patient with chronic lumbago is seen by the physician to have an epidural injection at the sacral level. What CPT® code is reported for this procedure? a. 62319 b. 62360 c. 62310 d. 62311

100

21. 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, 63035 d. 63030

100

31. 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 b. 60650, D35.01 c. 60540, C47.9 d. 60545, C47.9

100

43. 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 b. 63252, 69990 c. 63272 d. 63277

200

3. What is a laminotomy? a. Complete excision of lamina. b. Partial excision of one or more lamina. c. Removal of an invertebral disc. d. Removal of a portion of the invertebral body.

200

13. The physician 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 b. 60521 c. 60522 d. 60540

200

23. 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

200

33. 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 percent 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 six 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. Two cc containing equal parts preservative free 2 percent 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. 64493-50, 77003 d. 64493

200

45. 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 biopsy of the spinal cord under fluoroscopic guidance. The biopsy results come back as syringomyelia. What CPT® and ICD-10-CM codes are reported for the biopsy procedure? a. 62270, G12.9 b. 62270, G95.0 c. 62269, G12.9 d. 62269, G95.0

300

5. What are the four lobes of the brain? a. Frontal, Parietal, Temporal, Occipital b. Sulci, Cerebellum, Pons, Medulla c. Frontal, Cerebral, Cerebellum, Pons d. Frontal, Cerebrum, Temporal, Occipital

300

15. 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 b. M54.2 c. G89.21 d. M54.2, G89.21

300

25. 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 b. 62281, G44.1 c. 62273, G97.1 d. 62273, G44.1

300

37. 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

300

47. 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. 62272 c. 62282 d. 62319

400

7. What is the term for uncontrolled muscle movements? a. Paraplegia b. Reye’s Syndrome c. Syringomyelia d. Dyskinesia

400

17. 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 midline skull base. Dural repair is done and the area is closed with Neurolon. What CPT® code(s) is/are reported? a. 61521 b. 61524 c. 61598, 61608-51 d. 61597, 61608-51

400

27. A physician 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 b. 64802-50, I73.00 c. 64804, I73.01 d. 64804-50, I73.01

400

39. 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 portions of the surgery? a. 63087-52, 63088-52 x 2 b. 63085-62, 63086-62 x 2 c. 63087-80, 63088-80 x 2 d. 63085, 63086-82 x 2

400

49. 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 physician 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 b. 62362, C70.1 c. 62360, C70.0 d. 62367, C70.1

500

9. 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

500

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

500

29. 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? a. 62361, C70.1 b. 62362, C70.1 c. 96522, C41.2 d. 62360, C41.2

500

41. 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 of 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 b. 61564, Q78.1 c. 61563, D22.9 d. 61512, Q68.8

500

51. What ICD-10-CM code is reported for Addisonian crisis? a. E27.0 b. E27.1 c. E27.2 d. E27.40