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 The needle was withdrawn and the area bandaged.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
5. Max had a bilateral revision fenestration operation. How would you report this procedure?
a. 69840
b. 69840-50
c. 69820
d. Both a and c
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, 996.63D. 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. 62220B. 62223C. 62190D. 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. 64704B. 64713C. 64721D. 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. 67801B. 67805C. 67800D. 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, 63048-50B. 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. 66985B. 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, 381.20B. 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. 62311B. 62311, 77003-26
C. 62310, 77003-26D. 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. 67916-50B. 67916-E4, 67914-E2
C. 67914-50D. 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. 62272B. 62273
C. 62270, 62273D. 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. 66821D. 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-RTB. 64450-RT
C. 64614-RTD. 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 3B. 64405
C. 64413D. 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. 69420-50B. 69421-50
C. 69433-50D. 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-RTB. 65220-RT
C. 65222-RTD. 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-RTB. 60210-RT
C. 60220-RTD. 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, 77003-26B. 64493-50, 64494-50, 64495-50
C. 64493, 64494, 63395 x 4, 77003-26D. 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 rightear. 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 reportthis 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 subcutaneoustissues and skin are closed with deep sutures and skin staples. Carl tolerated the procedurewell and was returned to the recovery suite in stable condition. Which code(s) should be reported fortoday’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 patienttolerated 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
ANSWERS