CPC CHAPTER 14

Adrenal means:

Near the kidneys Response Feedback: Rationale: Adrenal means near the kidneys; the adrenal glands are above each kidney.

In ICD-10-CM which statement is TRUE regarding type I diabetes with peripheral angiopathy with gangrene?

One code is used to report diabetes with peripheral angiopathy; the gangrene is not reported separately. Response Feedback: Rationale: Look in the ICD-10-CM Alphabetic Index for Diabetes, diabetic/type 1/with peripheral angiopathy/with gangrene which directs you to E10.52. Verify code selection in the Tabular List.

What is a laminotomy?

Partial excision of one or more lamina. Response Feedback: Rationale: A laminotomy is partial excision of a vertebral lamina (placing a hole in the lamina). A laminectomy is complete excision of a lamina.

Select the HCPCS code to report a patient having a spinal needle inserted into the nucleus pulposus of the L3-L4 intervertebral disc until the desired decompression is accomplished using radio frequency energy.

S2348 Response Feedback: Rationale: Look in the HCPCS Level II Index for Decompression procedure, intervertebral disc guiding you to code S2348.

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?

60520 Response Feedback: Rationale: Excision of the thymus gland is a thymectomy and is coded based on the approach. Code 60520 is for a transcervical approach, as documented. In the CPT® Index look for Thymectomy/Transcervical Approach.

A neurosurgeon was called to the ER to examine a young child hit by a car. The neurosurgeon examines the patient with a diagnosis of a subdural hematoma and takes the child to the OR. Which modifier is appended to the Evaluation and Management service?

57 Response Feedback: Rationale: Modifier 57 is the appropriate modifier to append to the Evaluation and Management Service since the evaluation and examination of the child's condition led the surgeon to make a decision for surgery. This surgical procedure is a major procedure with a 90-day global period. Modifier 25 is only appended to minor procedures which have a 0-10-day global period. Modifiers 22 and 54 are only appended to procedure codes, not Evaluation and Management services

Under general anesthesia the provider excises the lower 1/3 portion of the right lobe of the thyroid as well as the lower 1/3 of the left lobe. The isthmus is also removed. What CPT® code(s) is/are reported?

60212 Response Feedback: Rationale: In the CPT® Index look for Thyroidectomy/Partial (only the lower 1/3 of the right and left sides are excised). You are directed to code range 60210-60225. 60212 reports a partial Thyroidectomy for both sides and includes the removal of the isthmus.

What CPT® code is reported for a subtotal thyroidectomy for malignancy, with removal of only a few selected lymph nodes?

60252 Response Feedback: Rationale: The removal of all of the lymph nodes of the neck during a thyroidectomy is considered a radical neck dissection. When limited removal of all of the lymph nodes of the neck is performed, it is reported with 60252. The thyroidectomy is performed due to the patient having a malignancy. In the CPT® Index look for Thyroidectomy/Total/for Malignancy/Limited Neck Dissection.

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 syringomyelia. What CPT® and ICD-10-CM codes are reported for the biopsy procedure?

62269, 76942-26, G95.0 Response Feedback: Rationale: In the CPT® Index look for Biopsy/Spinal Cord/Percutaneous and you are directed to code 62269. Instructional note under code 62269 indicates for radiological supervision and interpretation, see 76942, 77002, and 77012. Ultrasound guidance for needle placement, 76942, can be separately billed. Modifier 26 is appended for the professional services. In the ICD-10-CM Alphabetic Index look for Syringomyelia which directs you to code G95.0. Verification in the Tabular List confirms code selection.

A college student goes to the ER with symptoms of headache and high fever for the past two days. A Lumbar Puncture is performed and spinal fluid is sent to the lab to check for meningitis. What CPT® code is reported for this surgery?

62270 Response Feedback: Rationale: The patient is not having an injection or an aspiration of contents found in the nucleus pulposus, intervertebral disc, or paravertebral tissue. The procedure is a spinal puncture in the lumbar area to determine if the patient has meningitis. Look in the CPT Index for Spinal Tap/Lumbar guiding you to code 62270. Verify the code in the Nervous System section.

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?

62270 Response Feedback: Rationale: In the CPT® Index look for Puncture/Spinal Cord/Diagnostic or Spinal Tap/Lumbar. 62270 is the correct code because a spinal puncture was performed in the lumbar region (L4 and L5). It was done to withdraw cerebrospinal fluid for testing to determine if the patient had meningitis (diagnostic).

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-10-CM codes are reported?

62273, G97.1 Response Feedback: Rationale: In the CPT® Index look for Spinal Cord/Injection/Blood and you are directed to 62273. In ICD-10-CM Alphabetic Index, look for Headache/lumbar puncture and you are directed to G97.1. Verification in the Tabular List confirms code selection.

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?

62322 Response Feedback: Rationale: Documentation shows a single injection was given at the sacral level. Neither a catheter nor a device is documented as being used. In the CPT® Index look for Epidural/Injection or you can find the code in the CPT® Index by looking up Epidural/Administration/Drug. Single injection codes are selected based on the level of the spine injected. 62322 is the correct chioce.

A 59-year-old female with failed back syndrome has undergone a recent test dose of intrathecal narcotics with good pain response. She is brought to the operating room for preparation and insertion of Medtronic programmable pain pump and intrathecal catheter. What CPT® codes are reported for this surgery?

62362, 62350-51 Response Feedback: Rationale: The patient is having an insertion of a programmable pump and an intrathecal catheter implanted to infuse pain meds for pain management. An infusion of pain medications is not performed. Look in the CPT Index for Infusion Pump/Spinal Cord guiding you to codes 62361-62362. Look in the CPT Index for Catheterization/Spinal Cord guiding you to codes 62350-62351 for the second code. Look in the Nervous System section to select the correct code.

A patient with a neoplasm of the spinal meninges has a programmable pump implanted for chemotherapy administration. What CPT® and ICD-10-CM codes are reported?

62362, C70.1 Response Feedback: Rationale: In the CPT® Index look for Insertion/Infusion Pump/Spinal Cord and you are directed to code range 62361-62362. This is a programmable pump making 62362 the correct code selection. In ICD-10-CM Table of Neoplasms look for Neoplasm, neoplastic/spine, spinal (column)/meninges and select from the Malignant Primary column which directs you to C70.1. Verification in the Tabular List confirms code selection.

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-10-CM codes are reported for this procedure?

62362, C70.1 Response Feedback: Rationale: The procedure performed is implanting a programmable pump which allows the infusion of a medication (e.g., chemotherapy) for treatment. For insertion or implantation of the pump, in the CPT® Index look for Infusion Pump/Spinal Cord guiding you to codes 62361-62362. This is a programmable pump making 62362 the correct code selection. In ICD-10-CM Table of Neoplasms look for Neoplasm, neoplastic/spine, spinal (column)/meninges and select from the Malignant Primary column which directs you to C70.1. Verification in the Tabular List confirms code selection.

A patient with a herniated cervical disc undergoes a cervical laminotomy with a partial facetectomy and excision of the herniated disc at cervical interspace C3-C4. What CPT® and ICD-10-CM codes are reported?

63020, M50.21 Response Feedback: Rationale: A laminotomy is also known as a hemilaminectomy. In the CPT® Index look for Hemilaminectomy and you are directed to code range 63020 - 63044. The procedure performed was a cervical (C3-C4) laminotomy with partial facetectomy and excision of the herniated disc which makes 63020 the correct code. In the ICD-10-CM Alphabetic Index, look for Hernia/intervertebral cartilage or disc and you are directed to see Displacement, intervertebral disc. Look for Displacement/intervertebral disc NEC/cervical, cervicothoracic to code M50.2-. Verification in the Tabular List indicates a 5th character is reported to identify the intervertebral interspace of C3-C4. The 5th character 1 is chosen.

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 S1. 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?

63030-50, 69990 Response Feedback: Rationale: A laminotomy is also known as a hemilaminectomy. In the CPT® index look for Hemilaminectomy, and you are directed to code range 63020-63044. Code selection is based on the number of interspaces and the location of spine. This is the lumbar spine and only one interspace is treated making 63030 the correct code. The parenthetical instructions state to use modifier 50 for a bilateral procedure. This occurred on the left and right side so modifier 50 is appended. According to CPT®, 69990 is not inclusive to 63030 and is reported separately. According to the National Correct Coding Initiatives (NCCI), 69990 is inclusive and cannot be reported separately. For this note, we are following CPT® guidelines. We included it on all choices to avoid confusion.

A 47 year-old 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 was 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?

63267, 69990 Response Feedback: Rationale: In the CPT® Index look for Laminectomy/for Excision/Intraspinal Lesion/Other than Neoplasm and you are directed to code range 63265-63268 and 63270-63273. The code range is divided based on whether the lesion is extradural or intradural. In this case, it is extradural narrowing the range to 63265-63268 and 63270-63273. The range is further divided based on the location of the spine the lesion is located. Laminectomy with evacuation of an intraspinal lesion in the lumbar spine is described by code 63267. The use of a microscope is documented to perform microdissection. In the CPT® Index look for Operating Microscope which directs you to 69990.

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 of 5% Marcaine mixed with the steroid Decadron (16mg) into the nerve located in the facet joints at levels L3-L4 and L4-L5 on both sides at each level. What CPT® code(s) are reported for this procedure?

64493-50, 64494-50 Response Feedback: Rationale: Codes for the injection of an anesthetic and/or steroid are selected based on the location and number of levels. In the CPT® Index look for Injection/Paravertebral Facet Joint/Nerve/with Image Guidance directing you to 64490-64495. Code 64493 is for injection of the lumbar, single level L3-L4; and 64494 is the add-on code for the additional level L4-L5. Modifier 50 Bilateral Procedure is appended to both codes as the injection was on both sides.

A patient receives a paravertebral facet joint injection at three levels on both sides of the lumbar spine using fluoroscopic guidance for lumbalgia. What CPT® and ICD-10-CM codes are reported?

64493-50, 64494-50, 64495-50, M54.5 Response Feedback: Rationale: In the CPT® Index, look for Injection/Paravertebral Facet Joint/Nerve with Image Guidance and you are directed to 64490-64495. Code selection is based on the location of the spine (lumbar) and the levels injected. Modifier 50 is appended since it is bilateral. In the ICD-10-CM Alphabetic Index look for Pain/lumbar region and you are directed to M54.5. Verification in the Tabular List confirms code selection.

Postoperative Diagnosis: Carpal tunnel syndrome right wrist The patient was brought to the operating room and sedated with 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. 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 its 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 and the tourniquet was released. A dressing was applied and the patient was transferred to recovery room. What CPT® code is reported?

64721-RT Response Feedback: Rationale: In the CPT® Index look for Carpal Tunnel Syndrome/Decompression and you are directed to code 64721. Modifier RT is used to indicate it was performed on her right wrist.

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?

64831, 64832 Response Feedback: Rationale: Look in the CPT® Index for Suture/Nerve or Repair/Nerve/Suture. 64831 is the correct code to report the digital nerve was repaired. 64832 is the correct secondary code because there was an additional digital nerve repaired. Modifier 51 is not appended to the secondary code because this code is an add-on code and add-on codes are modifier 51 exempt.

What does contralateral mean?

Affecting or originating in the opposite side. Response Feedback: Rationale: Contralateral means affecting or originating in the opposite side. This term is often used in describing thyroid surgeries.

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 of the damaged nerve. What CPT® and ICD-10-CM codes are reported?

64885, 69990, S04.51XA Response Feedback: Rationale: A neurorrhaphy is a repair of the nerve that has been divided. In the CPT® Index look for Repair/Nerve/Graft and you are directed to code range 64885-64911. You can also look for Neurorrhaphy/Peripheral Nerve/with Graft. Code selection is based on the number of strands, location and length of the grafts. This is a 3 cm graft in the head which is coded with 64885. 69990 is reported to indicate the use of an operating microscope. In the ICD-10-CM Alphabetic Index look for Injury/nerve/facial and you are directed to S04.5-. Verification in the Tabular List indicates that seven characters are needed to complete the code. The 5th character is for laterality, reporting 1 for the right side. The placeholder X is reported for the 6th character and A for the 7th character extension supporting surgery for initial encounter.

What CPT® code is used to report neurorrhaphy with autogenous vein graft for one nerve?

64911 Response Feedback: Rationale: A neurorrhaphy is a repair of the nerve that has been divided. In the CPT® Index look for Repair/Nerve/Graft which directs you to code range 64885-64902, 64910-64913. 64911 is reported for a neurorrhaphy with autogenous vein graft.

A 50-year-old with left internal carotid artery stenosis presents for a left carotid thromboendarterectomy with electroencephalogram monitoring. Electroencephalogram (EEG) leads were placed on his head prior to surgery. Throughout the procedure, EEG patterns were symmetrical. What CPT® code is reported for this EEG Monitoring?

95955-26 Response Feedback: Rationale: The physician is using an EEG to record and measure the patient's brain electrical activity while performing the thromboendarterectomy (not intracranial surgery). Look in the CPT Index for Electroencephalography/Intraoperative guiding you to code 95955. Verify code selection in the Medicine section. Modifier 26 is added to report the physician's professional component of the procedure.

A patient sees her physician for follow-up of a repaired damaged nerve to her finger. During the visit she tells the doctor she fell and hit her little toe this morning; now it is red and swollen, and she wants to make sure it's not broken. The physician examines the toe and reassures her it is not fractured. The doctor also examines the finger which is healing well with no infection. Select the Evaluation and Management service for this visit.

99212-24 Response Feedback: Rationale: Even though the patient is in a post-operative period from surgery, the physician can bill this E/M visit and append modifier 24. The examination is unrelated to the nerve repair surgery. Modifiers 55 and 54 are only appended to surgical procedure codes not Evaluation and Management services.

A 42-year-old male with thyroid cancer is admitted to the hospital for hypersecretion of calcitonin (functional activity) caused by the cancer. Choose the ICD-10-CM code(s) to report.

C73, E07.0 Response Feedback: Rationale: When a patient has functional activity (thyrotoxicosis or disorders of thyrocalcitonin secretion) associated with a neoplasm, the neoplasm should be reported first and the functional activity caused by the neoplasm is reported as a secondary code. There is no documentation of the patient having a history of other cancers so a Z code is not appropriate. In the ICD-10-CM Alphabetic Index, look for Carcinoma/thyroid; there is no listing in the Alphabetic Index. Use the instruction - see also Neoplasm, by site, malignant which is next to Carcinoma. In the Table of Neoplasms, locate Neoplasm, neoplastic/thyroid (gland)/Malignant Primary (column) directing you to code C73. In the Tabular List, C73 states to "Use additional code to identify any functional activity." The second diagnosis code is in the Alphabetic Index under Hypersecretion/calcitonin directing you to code E07.0. Verify code selection in the Tabular List.

The nervous system is composed of what two parts?

Central and Peripheral Nervous Systems Response Feedback: Rationale: The nervous system is comprised of two parts: (1) Central Nervous System (CNS) which is the brain and spinal cord in command of the entire body movement and function. (2) Peripheral Nervous System (PNS) which incorporates all the nerves running throughout the body that sends information to, and receives instruction from the CNS.

What is the ICD-10-CM code for a cavernous hemangioma in intracranial structures?

D18.02 Response Feedback: Rationale: In the ICD-10-CM Alphabetic Index look for Hemangioma/cavernous/intracranial which directs you to D18.02. Verification in the Tabular List confirms code selection.

Select the code for a patient diagnosed with thyrotoxicosis crisis with an overactive nodular goiter.

E05.21 Response Feedback: Rationale: The diagnosis is indexed under Thyrotoxicosis/with/goiter/nodular/with thyroid storm guiding you to code E05.21. Verification in tabular indicates E05.21 is correct code (thyroid crisis/storm). Verify code selection in the Tabular List.

What diagnosis code is used for spinal meningitis?

G03.9 Response Feedback: Rationale: In the ICD-10-CM Alphabetic Index, look for Meningitis. Spinal is a nonessential modifier and you are directed to G03.9. Verification in the Tabular List confirms code selection.

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

G43 Response Feedback: Rationale: Migraines are reported with codes from category G43. These codes report if the migraine is with or without aura, intractable or not intractable, with or without status migrainosus.

What specificity is added to Alzheimer's disease in ICD-10-CM?

The onset of Alzheimer's disease. Response Feedback: Rationale: In ICD-10-CM the codes for Alzheimer's disease are expanded to specify early or late onset, other or unspecified.