2018 Chapter 14 -

Multiple Choice
Identify the choice that best completes the statement or answers the question.

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.
i
2. What is a parathyroidectomy?
a. Removal ofthe bottom part of the thyroid.
b. Removal of the upper part of the thyroid.
c. Removal of glands on the posterior surface ofthe thyroid.
d. Removal of glands beneath the thyroid. I
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 ofthe invertebral body.

4. When coding for surgery jjerformed on the Skull Base(61580-61598) what term describes the method used to
gain exposure to the lesion?
a. Definitive procedure c. Repair procedure
b. Radical procedure d. Approach procedure

5. What are the four lobes ofthe brain? i

a. Frontal, Parietal, Temporal, Occipital I
b. Sulci, Cerebellum, Pons, Medulla
c. Frontal, Cerebral, Cerebellum, Pons i
d. Frontal, Cerebrum, Temporal, Occipital i

6. What disease is characterized by enlarged skeletal parts? '

a. Acromegaly I c. Hyperthyroidism 1
b. Goiter i d. Cushing's Syndrome 1
I I
7. What is the term for uncontrolled muscle movements?
a. Paraplegia c. Syringomyelia
b. Reye's Syndrome d. Dyskinesia

8. What is the term for paralysis affecting one side ofthe body?
a. Monoplegia c. Quadriplegia
b. Paraplegia d. Hemiplegia

9. Looking in the CPT® manual the Nervpus 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
10. What is a dime sized opening in the skull to access the brain called?
a. Burr hole ' c. Cistern
b. Trephine > d. Craniectomy

11. 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 1
b. 62360 ! d. 62322
12. What is the ICD-IO-CM code for a cavernous hemangioma in intracranial structures?
a. D18.00 ' c. D18.03
b. D18.02 , d. Q82.5

13. 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 I d. 60540
14. What ICD-IO-CM code is used for intractable grand mal seizures without status epilepticus?
a. R56.9 c. G40.909
b. 167.89 d. G40.419

15. A patient is receiving pain management treatment for chronic cervical pain caused by a motor vehicle
accident. What ICD-IO-CM code(s) and sequencing is/are reported?
a. G89.21,M54.2 I c. G89.21
b. M54.2 j d. M54.2,G89.21
16. Under general anesthesia the provider excises the lower 1/3 portion of the right lobe ofthe 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 i c. 60210-LT,60210-RT
b. 60225-50 d. 60212

17. A 50 year-old male is diagnosed with a tumor ofthe 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 ofthe 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 I c. 61598,61616-51
b. 61524 t d. 61597,61616-51 '
18. A patient has a right thyroid lobectom>|for a thyroid follicular lesion. An incision is made 2 cm above the
sternal notch and carried through the pjatysma. 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

19. What ICD-IO-CM code is used for hemiplegia affecting the left dominant side?
a. R20.2 I c. G82.21
b. G81.92 d. G83.32
20. 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
j
21. A patient is having a decompression of the nerve root involving two segments ofthe lumbar spine via
transpedicular approach. What CPT® code(s) is/are reported?
a. 63056 c. 63030,63035 I
b. 63056,63057 d. 63030

22. What diagnosis code is used for spinal meningitis?

a. A39.9 c. G04.90
b. G03.9 d. A87.9
I
j
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 stemocleidomastoid muscles are performed to remove a malignant
lymphatic chain. What CPT® and ICD-IO-CM codes are reported?
a. 60254, C73 c. 60220, C32.3
b. 60252, C32.3 d. 60210, C73

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

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-IO-CM codes are reported?
a. 62282, G97.1 c. 62273, G97.1
b. 62281, G44.1 d. 62273, G44.1

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

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

27. A provider is performing an experimental cervical sympathectomy on a patient with Raynaud's Syndrome.
What CPT® and ICD-IO-CM codes are reported?
a. 64802,173.00 c. 64804,173.01
b. 64802-50,173.00 d. 64804-50,173.01

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

29. A patient with a neoplasm of the spinal meninges has a programmable pump implanted for chemotherapy
administration. What CPT® and ICD-IO-CM codes are reported?
a. 62361, C70.1 c. 96522, C41.2
b. 62362, C70.1 d. 62360, C41.2

30. A patient with a hemiated cervical disc undergoes a cervical laminotomy with a partial facetectomy and
excision of the hemiated disc at cervical interspace C3-C4. What CPT® and ICD-IO-CM codes are reported?
a. 63050, M50.21 c. 63020, 63035, M50.91
b. 63020, M50.21 d. 63050, M50.9I
31. A patient with a right side, benign adrenal adenoma has a laparoscopic adrenalectomy. What CPT® and ICD-
10-CM codes are reported?
a. 50545,035.01 c. 60540, C47.9
b. 60650,035.01 d. 60545, C47.9

32. 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 of5% Marcaine mixed with the steroid Oecadron(16mg)into the nerve located in the facetjoints at
levels L3-L4 and L4-L5 on both sides^ at each level. What CPT® code(s) are reported for this procedure?
a. 64493x2 c. 64493-50x4
b. 64493-50,64494-50 d. 64483-50,64484-50

33. Operative Report

PROCEDURE: Left L3-L4 peri-articular paravertebral facetjoint 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 facetjoint 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 facetjoint 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 ofthe left L3-L4
paravertebral facetjoint under fluoros'popic guidance. Injection of 0.5 cc ofIsovue 200 contrast showed the
needle was not in an intravascular location.
Intra-articular placement could not belconfirmed 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 j d. 64493
34. 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 drugjis injected
into the epidural space. What CPT® code(s) is/are reported for this procedure? I
a. 64483,64484 c. 64493,64494
b. 64493 d. 64483
j
35. 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 SI. 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

36. Postoperative Diagnosis: Carpal tunnel syndrome right wrist

The patient was brought to the operating room and sedated with anesthesia. After sterile prepping and draping
ofthe 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 ofthe 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 wasjcarried 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? 1 j
a. 64721-RT : c. 29848-LT i
b. 64721-LT d. 29848-RT ^

37. A patient receives a paravertebral facetjoint injection at three levels on both sides of the lumbar spine using
fiuoroscopic guidance for lumbalgia. What CPT® and ICD-IO-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

38. PROCEDURES PERFORMED:

1. Bilateral facetjoint injections, L4-L;5

I

2. Bilateral facetjoint injections, L5-Sil. i

3. Fluoroscopy. !
i

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 fiuoroscopic into each
facetjoint under AP image. The bilateral L4-L5, and L5-S1 facetjoints 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 j
b. 64493-50x2 ^ d. 64493-50,64494-50-51,77002-26 |
39. A 47 year-old female presents to the C)R for a partial corpectomy to three thoracic vertebrae. One Isurgeon
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. 63087-52,63088-52x2 i c. 63087-80,63088-80x2
b. 63085-62,63086-62x2 } d. 63085,63086-82x2
I

40. 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 i c. 64831,64837-51
b. 64834,64837-51 d. 64831,64832
I
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 offthe bone and
down through the dura mater. Prophylactic decompression ofthe optic nerve was also performed. What
CPT® and ICD-IO-CM codes are reported?
a. 61519, D32.9 c. 61563, D22.9
b. 61564, Q78.1 d. 61512, Q68.8

42. 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
ofthe damaged nerve. What CPT® and ICD-IO-CM codes are reported?
a. 64885, SI6.8XXA c. 64886, 69990, SI6.8XXA i
b. 64886, S04.51XD d. 64885,69990, S04.51XA

43. A 47-year-oId 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 w^as 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

44. 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-IO-CM codes are reported for the surgery? i
a. 60500, E21.3 c. 60505, E21.0 |
b. 60502, E21.3 d. 60^00, E21.0
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 needle biopsy of the spinal cord under ultrasound guidance in
the outpatient setting. The biopsy results come back as syringomyelja. What CPT® and ICD-IO-CM codes
are reported for the biopsy procedure? '' •■
a. 62270,012.9 c. 62269,012.9
b. 62270,76942-26,095.0 d. 62269,76942-26,095.0
46. A 41 year-old female has carpal tunnel syndrome in her left hand. The patient underwent release ofthe 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 ofthe
median nerve was performed using a magnifying loupes. What CPT® code is reported?
a. 64704 c. 64721
b. 64719 d. 64722
\

47. 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
48. 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 ofthe 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

49. 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-IO-CM codes are reported for this
procedure?
a. 62350, C70.0 c. 62360, C70.0
b. 62362, C70.1 d. 62367, C70.1
1

50. 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

51. What ICD-10-CM code is reported for Addisonian crisis?

a. E27.0 c. E27.2
b. E27.1 d. E27.40

52. In ICD-10-CM which statement is TRUE regarding type I diabetes with peripheral angiopathy with gangrene?
a. One code is used to report diabetes with peripheral angiopathy; the gangrene is not
reported separately. i
b. One code is used to report secondary diabetes with peripheral angiopathy; the gangrene is
not reported.
c. Two codes are reported; one to report diabetes with peripheral angiopathy and a second to
report the gangrene.
d. Three codes are reported; one for the diabetes, one for the peripheral angiopathy, and a
third for the gangrene.

53. How is Streptococcal A Meningitis reported in ICD-10-CM? ^

a. Only one code is reported for streptococcal meningitis.
b. Streptococcal meningitis is reported first; Streptococcal, group A,as the cause of diseases j
classified elsewhere is reported second.
c. Streptococcal, group A, as the cause of diseases classified elsewhere is reported first;
Streptococcal meningitis is reported second.
d. Only Streptococcal, group A, as the cause of diseases classified elsewhere is reported.
54. What specificity is added to Alzheimer's disease in ICD-IO-CM?
a. The stage of Alzheimer's disease, j
b. The onset of Alzheimer's disease. '
c. Neurological manifestations of Alzheimer's disease.
d. Visual disturbances associated with Alzheimer's disease.

55. Migraines are reported from what category in ICD-10-CM?

a. F02 I c. G30
b. GOO ! d. G43