60k answers

1. D. Nerve blocks are reported according to the nerve/plexus targeted. Medical terminology
comes in to selecting which code to choose. The question states that the injection was to a nerve
located between two ribs to block chest wall pain. The term intercostal is found in codes 64420 and
64421. The prefix inter means - between, within, or among. The term costal means - pertaining to
rib. This eliminates multiple choices A and C. There is a single injection, guiding you to CPT® code
64420. When more than one intercostal space is injected to achieve the regional block, report
64421.

2. B. The key word in this scenario is “ectropion,” which eliminates answer D referring to one
who has entropion. One of the eyelids had an excision of the tarsal wedge, coded with 67916.
Modifier E4 is appended to indicate the procedure was performed on the right lower lid. The other
eyelid had a suture repair coded with 67914, and modifier E2 is appended to it indicating the repair
was done on the left lower lid. A different procedure was performed on each eyelid. Modifier 50
would not be appended to the codes because both lids did not have the same procedure performed.

3. B. The key words in this encounter to guide you to the correct answer choice are "blood
patch" and “injection”. 62273 is the correct code because the patient’s blood is injected to plug the
wound that is causing the CSF leak (blood patch). This is the only code to bill for this visit, because
the lumbar puncture was performed three days ago.

4. B. Code 67145 is the correct procedure code because the patient had a retinal break and the
physician uses a laser light (photocoagulation) to seal the retina back into place.

5. A. laminectomy is performed, eliminating multiple choice B. The laminectomy is performed

with a facetectomy and foraminotomy. Modifier 50 is not reported with code 63047 since bilateral is
included in the code description.

6. C. Patient already has a shunt; a new one is not being created, eliminating multiple choice A.
There is a replacement of the valve and ventricular catheter; not a removal of the whole shunt
system.

7. D. An intracapsular catatract extraction is being performed. An intraocular lens prosthesis

(Cystalens) was inserted in the same surgery session with the cataract extraction. Code 66985 is
reported when only an intraocular lens is being inserted on a patient who had previously undergone
cataract removal.
8. C. The patient is implanting the osseointegrated implant for the first time, not a
replacement. Documentation does not support that a mastoidectomy was performed with the
implantation procedure.

9. C. The patient is having a “thyroid lobectomy,” eliminating multiple choice answers A and D,
which is a thyroidectomy (removal of the thyroid). 60220 is the correct code since the scenario
indicates that a small thyroid lobe (total lobe) is dissected free; it does not indicate that part of the
lobe was removed.

10. D. When coding for facet joint or facet joint nerve injections, you report each level that is
injected. In this case, the joints for L4-L5 and L5-S1 were injected. The codes for facet joint and facet
joint nerve injections are unilateral. The procedure was performed bilaterally at each level, therefore
modifier 50 should be reported. A parenthetical note states: If ultrasound guidance is used, report
0213T-0218T The ultrasound guidance should not be reported separately.

11. C The keywords in this craniectomy procedure to guide you to the correct code are cervical
(C-1 and C-2) laminectomy, medulla, and Chiari malformation found in the code description of code
61343.

12. C This was a removal of an intrathecal catheter and pump, eliminating multiple choice
answer D. The pump is not being implanted or replaced eliminating multiple choice answer B. Nor is
the intrathecal catheter being implanted, revised or repositioned eliminating multiple choice answer
A. Diagnosis Rationale: This was a complication; an infection due to a nervous system implant,
eliminating multiple choice answers A and D. Seroma is mentioned in the documentation, but there
is an “excludes” note for code 998.51, for infection due to an implanted device (996.60-996.69),
eliminating multiple choice answer B.

13. B This key word to choose the correct shunt being performed is “ventriculo-peritoneal”,
leading you to multiple choice answer B.

14. D Laminectomy was performed, eliminating multiple choice answer B. Facetectomy and
foraminotomy were performed, eliminating multiple choice answer C. The laminectomy is
performed bilaterally on three segments of the cervical. Modifier 50 is not appended to code 63045-
63048, since the code descriptive has a parenthetical note indicting that these codes include
unilateral or bilateral, eliminating multiple answer A.
15. D The patient is having the injection in the paravertebral facet joints, eliminating multiple
choice answers A and C. The code description for code 64490 has the fluoroscopic guidance included
in the code, meaning that it should not be coded separately. Also there is a parenthetical note under
code 64492 that states not to report 64492 more than once per day, eliminating multiple choice
answer B.

16. C The key term to choose the correct answer is “median nerve”, found in code 64721.

17. C The surgery is an extracapsular cataract removal, eliminating multiple choice D. The
removal of the cataract and the insertion of the lens were performed at the same time, eliminating
multiple choice A. The keyword to choose between codes 66982 and 66984 is “iris expansion device”
which was used to remove the cataract, eliminating multiple choice answer B.

18. D There is more than a single chalazion to be removed, eliminating multiple choice answer
C. The chalazion was on the upper and lower lid, eliminating multiple choice answer A. The patient
was under general anesthesia, eliminating multiple choice answer B.

19. B The procedure being performed is an entropion repair on the left lower eyelid, eliminating
multiple choice answers A and D. Since there was a tarsal strip performed the procedure is an
extensive repair, eliminating multiple choice C.

20. A The patient is under general anesthesia eliminating multiple choice answer C. A
ventilating tube was placed in the ears eliminating multiple choice answer D. The diagnosis is
indexed in the ICD-9-CM manual under Otitis/ media/chronic/ mucoid, mucous guiding you to code
381.20, eliminating multiple choice answer B.

21. C

22. A

23. B – (WITHOUT 72265)

24. D The surgical term for this procedure is iridectomy.

25. C

26. B 62322-LT (The injection codes were revised in 2000; only one injection code is reported at
a particular level. See CPT Assistant, January, 2000, p. 3).

27. B. 61107 identifies the ventriculostomy for implanting a ventricular catheter. 12034-51
identifies the layered closure 7.6 to 12.5 cm of the scalp. 12015-51 identifies the repair code for the
face and eyelid, 7.6 to 12.5 cm. The -51 modifier is added to the 12015 and 12034 to indicate
multiple procedures.
28. C. 67935 indicates a full-thickness reconstruction of the eyelid. E2 indicated lower, left
eyelid. 12056-51 indicates the repair of 24.2 cm of lacerations above the eye and brow (face) using
intermediate (full-thickness) repair. The -51 modifier is attached to indicate multiple procedures.

29. D. 62270 indicates aspiration of fluid from the spine (lumbar puncture). 780.6 correctly
identifies the only diagnosis listed, that of fever.

30. A. 63030-LT identifies the hemilaminectomy with excision of herniated disk from one
interspace, lumbar region (L4-5). LT indicates the left side. 722.10 is the diagnosis for the herniated
disk, lumbar region (L4-5).

31. C. 61150 identifies the burr holes with drainage of brain abscess. G06.0 is the diagnosis for
the intracranial abscess as stated in the report.

32. B. 62258 identifies the complete removal and replacement of the cerebrospinal shunt
system. 996.2 is the diagnosis for a mechanical complication of a nervous system device, ventricular
shunt.

33. D. 63042-LT identifies the reexploration of a lumbar interspace with excision of a herniated
disk. LT indicates the left side was done. 722.10 is the diagnosis of a herniated lumbar disk.

34. A. 60210 identifies a partial unilateral thyroid lobectomy with isthmusectomy.

35. D. 67880-LT is an operative procedure in which the surgeon temporarily sutures the eyelid
closed; this is used with some conditions of the eyelid in which the margins of the eyelid are rough
and irritate the cornea. Before the closure, the surgeon repairs the eyelid, and so when the sutures
are removed, the margin irregularity will have been repaired and no longer cause irritation. The -LT
indicates that the procedure was performed on the left eye, and 374.12 correctly describes the
condition stated in the report of paralytic ectropion.

36. B. 66984-RT is the extracapsular cataract extraction (ECCE), in which the nucleus of the lens
capsule and the front (anterior) shell are removed. An intracapsular cataract extraction (ICCE) is
when both the lens and the capsule are totally removed intact. Phacoemulsification is a process in
which the lens is softened with ultrasound and the fragments are aspirated out of the area and an
IOL (intraocular lens) prosthesis is inserted. 366.14 is a posterior subcapsular senile cataract removal
as indicated in the report.