Focus Healthcare Solution

Nervous System
Duration : 1hr 15 min
Marks : 30

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, 77012-26 B. 60300 x 2, 77012-26

C. 10009, 10010 D. 10009 x 2

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 The needle was withdrawn and the area bandaged.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. Kaaliappan had sensorineural hearing loss on his right ear. Otolaryngologist performed Tympanostomy and
Labyrinthotomy and injected steroid. What CPT code you would report for the Otolaryngologist?

A. 69436 - RT, H90.41 B. 69905 - RT, H90.A21

C. 69436 - RT, 69801 - RT, H90.41 D. 69801 - RT, H90.41

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?

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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 codes for this procedure?

A. 62365, 62350-51 B. 62360, 62355

C. 62365, 62355-51 D. 36590

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. 62220 B. 62223 C. 62190 D. 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. 64704 B. 64713 C. 64721 D. 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. 67801 B. 67805 C. 67800 D. 67808

15. MRI reveals patient has cervical stenosis. It was determined he should undergo bilateral cervical laminectomy at
C3 through C6. The edges of the laminectomy were then cleaned up with a Kerrison and foraminotomies were done

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at C3, C4, C5 and C6. The stenosis is central and 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

16. An extracapsular cataract removal is performed on the right eye by manually using an iris expansion device to
expand the pupil. A phacoemulsification 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. 66985-RT B. 66984-RT C. 66982-RT D. 66984 -22, RT

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-10-CM codes should be reported:

A. 69436-50, H65.30 B. 69436-50, H65.90

C. 69433-50, H65.90 D. 69421-50, H65.30

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 T2T3,
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 B. 64490, 64491, 64492x2

C. 64520x4 D. 64490, 64491, 64492

20. An entropion 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
L4L5 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. 62282 B. 62323 C. 62321 D. 62327

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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. 67916-50 B. 67916-E4, 67914-E2 C. 67914-50 D. 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 etiology 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. 62272 B. 62273 C. 62270, 62273 D. 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. 66821 D. 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.

Procedure: 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-RT B. 64450-RT C. 64721-LT D. 29848-RT

27. Rudhran has muscle spasm on his hand, leg and paraspinal muscles for which he encountered for Chemo
denervation. Total of 4 muscles in his right upper arm, 6 muscles in left leg and 4 paraspinal muscles were involved
in the procedure. How would you report this service?
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 a. 64644-LT, 64642-RT, 64646-51 b. 64644, 64642, 64646-51
c. 64642-RT, 64645-LT, 64646-51 d. 64644, 64643, 64646-51

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. 69420-50 B. 69421-50 C. 69433-50 D. 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-RT B. 65220-RT C. 65222-RT D. 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 sternocleidomastoid 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-RT B. 60210-RT C. 60220-RT D. 60260-RT

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