60000 Series (10Q) - Try Free Quiz
1. Surgeries of the skull base are often categorized according to three things. Which of the following includes the three things by which surgeries of the skull base are categorized?
A. Approach procedure, biopsy, and definitive procedure
B. Gaining access to the lesion, approach procedure, and definitive procedure
C. Definitive procedure, approach procedure, and repair or reconstruction
D. Definitive procedure, repair, and reconstruction
2. PROCEDURAL NOTE
PATIENT: Lopez, Olga
AGE: 76 years
DATE: 11/05/2014
PATIENT DIAGNOSIS: Multiple Skull Lymphoma
PROCEDURE: Craniotomy converted to craniectomy of left anterior cranial base ANESTHESIA: General endotracheal The patient was placed in supine position on operating table and anesthesia was successfully administered. The patient was prepped in the usual manner. An incision was made on the midline of the patient’s anterior cranial base and the surgeon dissected the epidermal layer to reveal the skull. Three .2 to .4 cm lymphomas were located and the skull bone was excised in one piece to remove the affected are as leaving a .1 cm margin. Halfway through the procedure the patient’s blood pressure dropped. It was difficult to control throughout the remaining procedure. Due to the patient’s drop in blood pressure, the surgeon decided to convert the procedure to a craniectomy, so that bone grafts were not placed. A drain was placed beneath the remaining skull base and the edges of the skin were then sutured back together using 4-0 vicryl sutures. A sterile dressing was placed on the excision site. The patient was removed from endotracheal anesthesia and remained under physician supervision until her blood pressure stabilized. The patient was taken to the recovery room and scheduled for a bone graft at a later date. What is the correct code for this surgery?
A. 61500 -52
B. 61518
C. 61500 -53
D. 61500
3. A physician performed craniotomy on a patient with a severe head trauma and intracerebral hematoma. Due to the patient’s condition the procedure was extremely difficult, requiring a significant amount of extra time and effort. What is the correct code for this procedure?
A. 61315
B. 61313
C. 61313 -22
D. 61315 -23
4. A physician utilized a laser and neuroendoscopic guidance to create a duct from the third lateral ventricle to the cisterna magna as a treatment for hydrocephalus. What is the correct code for this procedure?
A. 62200 B. 62201 C. 62220 D. 62180
5. A pediatrician performed a lumbar puncture on a 2-day-old premature infant weighing 2.3 kg with possible meningitis. What is the correct code for this service?
A. 62272 B. 62272 C. 62270 -63 D. 62272 -63
6. A physician performed a right lumbar hemilaminectomy with decompression of nerve root, including the excision of two herniated intervertebral discs for three vertebral interspaces. How should the physician code for this service?
A. 63030, 63035 (X2)
B. 63020, 63035 (X2)
C. 63042, 63044 (X2)
D. 63042, 63044
7. A 59-year-old patient with continuous post-traumatic pain received a tunneled epidural catheter for long-term pain medication administration by use of an external pump. The patient was previously implanted with an intrathecal pump, which was ineffective for the patient’s pain management. Before the implantation of the epidural pump, the physician removed the intrathecal catheter. What are the correct CPT codes for this service?
A. 62350
B. 62350, 62355 -51
C. 62351, 62355
D. 62350, 62355
8. A physician performed the excision of an intra spinal intra dural neoplasm of the sacral area. What is the correct code for this procedure?
A. 63275 B. 63275 C. 63278 D. 63283
9. A pediatric neurologist performed a repair of 3.4 cm meningocele on 40-day-old infant with spina bifida weighing 3 kg. Due to the location, size and depth of the meningocele, complex closure of 7 cm wound was required. What are the correct codes for this procedure?
A. 63700 -63, 13101 -51
B. 63700, 13120
C. 63700 -63, 13101
D. 63700, 13101 -51
10. A physician sutured 3 digital nerves in the left hand, the common sensory nerve in the left foot and two common sensory nerves in the right foot. What codes need to be reported?
A. 64831, 64832 (X2), 64834, 64837 (X2)
B. 64831, 64832, 64834, 64837
C. 64831, 64832 (X4), 64834
D. 64831, 64834, 64837 (X4)
1. Answer: C - Definitive procedure, approach procedure, and repair or reconstruction are the three things by which surgeries of the skull base are categorized. The approach procedure is the procedure that is done to gain access or exposure to the lesion or operation site. The definitive procedure is the actual biopsy, excision, or treatment of the lesion or operation site. The repair or reconstruction procedure is only reported separately if it is extensive or complicated, and it includes the closure of the surgical site such as skin grafts.
2. Answer: D - The correct code for the surgery is 61500 (Craniotomy; with Excision of Tumor or Other Bone Lesion of Skull).Modifier -52 and -53 do not need to be used to indicate that it was a discontinued procedure because the procedure was completed. The original procedure, a craniotomy was converted to a modified procedure, a craniotomy. Code 61518 is also incorrect because it is used for a craniotomy, for the excision of brain tumor, rather than excision of bone lesion of skull.
3. Answer: C - The correct code for the procedure is 61313 (Craniectomy or Craniotomy for Evacuation of Hematoma, Supratentorial; Intracerebral) combined with modifier -22 to indicate that the procedure was an increased procedural service. Code 61315 is inappropriate because it is used for an infratentorial, intracerebellar hematoma.
4. Answer: B - The code for the procedure is 62201 (Ventriculocisternostomy, Third Ventricle; Sterotactic, Neuroendoscopic Method). Code 62200 is for the same procedure, but without using the neuroendoscope. Code 62180 is also for the same procedure, but it does not take into account the third ventricle. Code 62220 is used for the creation of a shunt, but in this case, a shunt was not created.
5. Answer: C - The correct code for this service is with 62270 (Spinal Puncture, Lumbar, Diagnostic) combined with modifier -63 to indicate that the patient weighed less than 4 kg. Code 62270 (Spinal Puncture, Therapeutic, for Drainage or Cerebrospinal Fluid) is incorrect because the lumbar puncture was performed to evaluate the spinal column fluid not treat the spinal column by performing the lumbar puncture.
6. Answer: A - The physician should code for this service with codes 63030 (Laminotomy (Hemilaminectomy), with Decompression or Nerve Root(s), Including Facetectomy, Foraminotomy and/or Excision of herniated Intervertebral Disc; 1 Interspace, Lumbar) with the add-on code 63035 (Each Additional Interspace, Cervical or Lumbar). Although there were only two herniated discs removed, there were three interspaces involved in the procedure therefore the correct number of units for the add-on code 63035 is two.
7. Answer: B - The correct CPT codes for this service are 62350 (Implantation, Revision, or Repositioning of Tunneled, Intrathecal or Epidural Catheter, for Long-term Medication Administration via an external pump or implantable reservoir/infusion pump; without Laminectomy and 62355 (Removal of previously implanted intrathecal or Epidural Catheter)
The removal of the intrathecal catheter needs to be coded separately with modifier -51, indicating that it was multiple procedures.
8. Answer: D - The correct code for the procedure is 63283 (Laminectomy for Biopsy/Excision of Intra spinal Neoplasm; Intra dural, Sacral). Code 63275 is incorrect because it is used for an extradural, cervical lesion. Code 63273 is incorrect because it is used for the excision of a lesion other than a neoplasm, and code 63278 is incorrect because it is used for an extra dural, sacral lesion.
9. Answer: D - The correct codes for this procedure are: 63700 (Repair of Meningocele; Less than 5 cm Diameter) and 13101 (Repair, Complex, Trunk; 2.6 cm to 7.5 cm). Code 63700 should not be appended with modifier -63 because the coder is specifically instructed not to append modifier - 63 to the code in parenthesis under the code. Modifier -51 should be appended to 13101to indicate that it was multiple procedures.
10. Answer: A - The codes that need to be reported are: 64831 (Suture of Digital Nerve, Hand or Foot; 1 Nerve) and 64832 (Suture of Digital Nerve, Hand or Foot; Each Additional Digital Nerve) with two units. These codes include all three sutures for the digital nerves in the left hand. The other codes that need to be reported are 64834 (Suture of 1 Nerve; Hand or Foot, Common Sensory Nerve) and 64837 (Suture of Each Additional Nerve, Hand or Foot) with two units. This accounts for the three additional common sensory nerves that were sutured in the feet.