Nervous System

1) 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, 996.63
D. 36590, 996.75, 998.13

2) 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. 62220
B. 62223
C. 62190
D. 62192

3) What is the CPT code for the decompression of the median nerve found in the space in the
wrist on the palmar side?
A. 64704
B. 64713
C. 64721
D. 64719
4) 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, 63048-50
B. 63020-50, 63035-50, 63035-50
C. 63015-50
D. 63045, 63048 x 3

5) 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

6) 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

7) The operating physician provides 1 hr of microelectrode recording in association with a

craniotomy for the plantation of 2 neurostimulator electrode arrays. What is the choice for
reporting the physician's services?
a) 61864, 95961
b) 61863, 61864, 95961, 95962
c) 61867, 61868
d. 61863 26
d) (5-111) Assign the appropriate code(s) for the following procedures: Lumbar facet joint nerve
injection, unilateral, multiple levels, L3 and L4 medial branch nerves/facet joint nerves and L5 dorsal
ramus for the L4-L5 and L5-S1 joints using fluoroscopic guidance. (287)

a. True, 95974 and 95975 are used

b. 62310, 72275, 62311 72275 59

c. 64475, 64476, 77003 26 (Question: How do we find?)

d. 70450, 70460, or 70470; and 70551, 70552, or 70553

e) (5-108) Assign the appropriate code(s) for epidurography at the cervical and lumbar region. (276 /
CPT 248)

a. 62351

b. 61609-61612

c. 61618

d. 62310, 72275, 62311 72275 59

f) (5-118a) Assign the appropriate code(s) for the following procedures: Catheter implantation of an
intrathecal or epidural catheter, connected to an external pump, implantable reservoir, or
implantable infusion pump, without laminectomy. (280)

a. 62351

b. 62350

c. 63030

d. 61618

g) False

a. (5-124) True or False: Codes 64612-64614 are reported once, even though multiple
injections are performed. (289)

b. (5-119) True or False: Code 62350 is only intended to describe medication administration
for long-term pain management. (280)
 c. (5-113) True or False: Craniotomy procedures 61340 and 61490 may be performed
unilaterally or bilaterally. (264)

d. (5-106) True or False: Codes 62200 and 62201 may be used to describe third ventricle
ventriculocisternostomy performed by stereotactic method only. (274)

h) (5-104) True or False: For endovascular temporary balloon arterial occlusion, head or neck
(extracranial or intracranial) (61623), the selective catheterization of the vessel to be occluded,
positioning, and inflation of the occlusion balloon are included and not additionally reported. (267)

a. Yes

b. 62351

c. False

d. True

i) 64483 50, 64484 50, 77003 26 (Question: CPT 223 "with imaging guidance (fluoroscopy or CT)" ---
Book "Code 77003 is not an inclusive component of 64479-64484", why use 77003 26?)

a. (5-111) Assign the appropriate code(s) for the following procedures: Lumbar facet joint
nerve injection, unilateral, multiple levels, L3 and L4 medial branch nerves/facet joint nerves
and L5 dorsal ramus for the L4-L5 and L5-S1 joints using fluoroscopic guidance. (287)

b. (5-118b) Assign the appropriate code(s) for the following procedures: Catheter implantation
of an intrathecal or epidural catheter, connected to an external pump, implantable reservoir,
or implantable infucion pump, with laminectomy. (280)

c. (5-118a) Assign the appropriate code(s) for the following procedures: Catheter implantation
of an intrathecal or epidural catheter, connected to an external pump, implantable reservoir,
or implantable infusion pump, without laminectomy. (280)

d. (5-110) Assign the appropriate code(s) for the following procedures: Lumbosacral
transforaminal epidural injection bilateral, multiple levels, left and right L4-L5 foramen, L4
spinal nerves and left and right L5-S1 foramen, L5 spinal nerves using fluoroscopic
guidance. (289/CPT 223)

j) (5-105) Code 61626 describes the permanent occlusion of one or more extracranial vessels (eg,
arteriovenous malformation, tumor destruction of the head or neck [non-CNS]). Is it appropriate to
report 75894 (transcatheter therapy, embolization) and 75898 (post-embolization arteriography) in
addition to 61624? (267)

a. 62351
 b. True

c. False

d. Yes

k) False (Book answer is True?)

a. (5-119) True or False: Code 62350 is only intended to describe medication administration
for long-term pain management. (280)

b. (5-124) True or False: Codes 64612-64614 are reported once, even though multiple
injections are performed. (289)

c. (5-106) True or False: Codes 62200 and 62201 may be used to describe third ventricle
ventriculocisternostomy performed by stereotactic method only. (274)

d. (5-113) True or False: Craniotomy procedures 61340 and 61490 may be performed
unilaterally or bilaterally. (264)

l) (5-123) Botulinum toxin injection into the lumbar trunk muscles results in what effect: destruction or
chemodenervation? (289)

a. Chemodenervation

b. Unilateral

c. Yes

d. False

m) 62351

a. (5-118b) Assign the appropriate code(s) for the following procedures: Catheter implantation
of an intrathecal or epidural catheter, connected to an external pump, implantable reservoir,
or implantable infucion pump, with laminectomy. (280)

b. (5-118a) Assign the appropriate code(s) for the following procedures: Catheter implantation
of an intrathecal or epidural catheter, connected to an external pump, implantable reservoir,
or implantable infusion pump, without laminectomy. (280)

c. (5-109) Assign the appropriate code(s) for the following procedures: Secondary repair of
CSF leakage following skull base surgery by free tissue graft. (266)

d. (5-110) Assign the appropriate code(s) for the following procedures: Lumbosacral
transforaminal epidural injection bilateral, multiple levels, left and right L4-L5 foramen, L4
 spinal nerves and left and right L5-S1 foramen, L5 spinal nerves using fluoroscopic
guidance. (289/CPT 223)

n) (5-125) Is facet joint nerve destruction by a neurolytic agent considered a unilateral or a bilateral
procedure? (290)

a. True

b. Unilateral

c. False

d. Yes

o) (5-117) True or False: The neurostimulator revision/removal code 63660 does not include evaluative
testing, programming, or reprogramming. (272)

a. True, 95974 and 95975 are used

b. 62310, 72275, 62311 72275 59

c. False (Book answer is True?)

d. Unilateral

p) (5-112) True or False: Burr hole(s) or trephine procedures (codes 61250, 61253) may not be reported
if followed by a craniotomy at the same operative session. (263)

a. Yes

b. False

c. 62350

d. True

q) (5-116) List the radiological S&I code separately reportable in addition to codes 61750 and 61751.
(268)

a. 62310, 72275, 62311 72275 59

b. True, 95974 and 95975 are used

c. False, 62263 and 62264 include 72275 and 77003

d. 70450, 70460, or 70470; and 70551, 70552, or 70553

r) (5-122) True or False: The term reexploration in the CPT code series 63040-63044 is associated with
a specific time frame from the initial procedure. (280)

a. 62350

b. Yes

c. False

d. True

s) (5-115) True or False: The mounting of a stereotactic head frame is reported by code 20660 when
performed by the same physician at the time of stereotactic biopsy of an intracranial lesion. (271)

a. False

b. True

c. 62350

d. Yes

t) (5-120) Code for refilling and maintenance of an implantable pump or reservoir for systemic drug
delivery. (CPT 355)

a. 96522

b. 61618

c. 63030

d. False

u) 61618

a. (5-118a) Assign the appropriate code(s) for the following procedures: Catheter implantation
of an intrathecal or epidural catheter, connected to an external pump, implantable reservoir,
or implantable infusion pump, without laminectomy. (280)

b. (5-110) Assign the appropriate code(s) for the following procedures: Lumbosacral
transforaminal epidural injection bilateral, multiple levels, left and right L4-L5 foramen, L4
spinal nerves and left and right L5-S1 foramen, L5 spinal nerves using fluoroscopic
guidance. (289/CPT 223)

c. (5-118b) Assign the appropriate code(s) for the following procedures: Catheter implantation
of an intrathecal or epidural catheter, connected to an external pump, implantable reservoir,
or implantable infucion pump, with laminectomy. (280)
 d. (5-109) Assign the appropriate code(s) for the following procedures: Secondary repair of
CSF leakage following skull base surgery by free tissue graft. (266)

v) (5-113) True or False: Craniotomy procedures 61340 and 61490 may be performed unilaterally or
bilaterally. (264)

a. 62351

b. Yes

c. True

d. False

w) (5-121) Code for endoscopically assisted laminotomy. (280)

a. 61618

b. 62350

c. 63030

d. 62351

x) True

a. (5-106) True or False: Codes 62200 and 62201 may be used to describe third ventricle
ventriculocisternostomy performed by stereotactic method only. (274)

b. (5-119) True or False: Code 62350 is only intended to describe medication administration
for long-term pain management. (280)

c. (5-124) True or False: Codes 64612-64614 are reported once, even though multiple
injections are performed. (289)

d. (5-115) True or False: The mounting of a stereotactic head frame is reported by code 20660
when performed by the same physician at the time of stereotactic biopsy of an intracranial
lesion. (271)

y) (5-107) True or False: None of the spinal injection codes (62263, 62264, 62270-62273, 62280-62282,
and 62310-62319) include fluoroscopic guidance and localization for placement of the needle or
catheter. (276)

a. 62310, 72275, 62311 72275 59

b. False, 62263 and 62264 include 72275 and 77003

 c. True, 95974 and 95975 are used

d. False (Book answer is True?)

z) 61609-61612

a. (5-121) Code for endoscopically assisted laminotomy. (280)

b. (5-114) List the skull base surgery add-on codes. (266)

c. (5-116) List the radiological S&I code separately reportable in addition to codes 61750 and
61751. (268)

d. (5-118b) Assign the appropriate code(s) for the following procedures: Catheter implantation
of an intrathecal or epidural catheter, connected to an external pump, implantable reservoir,
or implantable infucion pump, with laminectomy. (280)

aa) 1.What is the correct CPT code for surgery of a simple cranial aneurysm, intracranial
approach, carotid circulation?

a. 61700
b. 61702
c. 61703
d. 61705

bb) 2.What is the correct CPT code for a percutaneous transcatheter permanent occlusion for
tumor destruction for the central nervous system?

a. 61624
b. 61626
c. 61630
d. 61635

cc) 3.What is the correct CPT code for excision of a neoplastic lesion of the base of the
infratemporal fossal; extradura?

a. 61600
b. 61601
c. 61605
d. 61606

dd) 4.What is the correct CPT code for an intracerebellar craniotomy for evacuation of an
infratentorial hematoma?

a. 61312
b. 61313
c. 61314
 d. 61315

ee) 5.What is the correct CPT code for burr holes with drainage of brain abscess?

a. 61108
b. 61140
c. 61150
d. 61156

. What is the correct CPT code for a laminectomy for excision of a sacral intradural lesion
other than a neoplasm?

a. 63270
b. 63271
c. 63272
d. 63273

2.What is the correct CPT code for a laminectomy for a biopsy of an intradural extramedullary
thoracic neoplasm?

a. 63250
b. 63276
c. 63281
d. 63286

3.What is the correct CPT code for an extradural thoracic complete vertebral corpectomy by
transthoracic approach for excision of an intranspinal lesion of a single segment?

a. 63300
b. 63301
c. 63302
d. 63303

4.What is the correct CPT code for a laminotomy with decompression of the nerve root,
including excision of a herniated intervertebral disk for one lumbar interspace?

a. 63020
b. 63030
c. 63035
d. 63040
5.What is the correct CPT code for a partial cervical verterbral corpectomy of s single segment
using an anterior approach with decompression of the spinal cord and nerve root?

a. 63081
b. 63082
c. 63085
d. 63087