AAPC CHAPTER 14 EXAMINATION STUDY SHEET Questions
with Correct Answers (Grade A+)
Question 1: A 37 year-old has multilevel lumbar degenerative disc disease and is coming in for an
epidural injection. Localizing the skin over the area of L5-S1, the provider uses the transforaminal
approach. The spinal needle is inserted and the patient experienced paresthesia in her left lower
extremities. The anesthetic drug is injected into the epidural space. What CPT® code(s) is/are reported
for this procedure?
Answer: 64483.
Question 2: Operative Report PROCEDURE: Left L3-L4 peri-articular paravertebral facet joint
injection. PATIENT HISTORY: The patient is a 67 year-old woman referred by Dr. X for repeat
diagnostic/therapeutic spinal injection procedure. She is about 1 1/2 years status post lumbar
decompression for stenosis. Two weeks ago she underwent an interarticular left L4-L5 paravertebral
facet joint injection. She had no relief of symptoms from that injection. TECHNIQUE: The patient was
positioned prone and the skin was prepped and draped in the usual sterile fashion. The skin and
underlying soft tissues were anesthetized with 3 cc of 1% lidocaine. Due to the advanced degenerative
changes, the left L3-L4 paravertebral facet joint could not be distinctly visualized fluoroscopically,
despite trying numerous angles. This was explained to the patient who wished to proceed with the
injection. A 22-gauge 6-inch spinal needle was advanced toward the region of the left L3- L4
paravertebral facet joint under fluoroscopic guidance. Injection of 0.5 cc of Isovue 200 contrast showed
the needle was not in an intravascular location. Intra-articular placement could not be confirmed and
the injection was presumed to be peri-articular. 2 cc containing equal parts preservative free 2%
Lidocaine plus Depo-Medrol (80 mg per ml) was injected. The patient reported injection of medication
produced discomfort in the region of her usual left low back pain. Immediately following the
procedure, upon standing up from the procedure table, she reported her pain was a little bit better.
What CPT® code(s) is/are reported for this procedure?
Answer: 64493.
Question 3: PROCEDURES PERFORMED:
1. Bilateral facet joint injections, L4-L5
2. Bilateral facet joint injections, L5-S1.
3. Fluoroscopy. TECHNIQUE: The AP view was aligned with the proper tilt so that the end plates for the
desired levels were perpendicular. The AP image showed the sacrum and the L5 spinous process. Manual
palpation located the sacral hiatus. The 6 inch, 20 gauge needle with a slight volar bend was inserted using
fluoroscopic into each facet joint under AP image. The bilateral L4-L5, and L5-S1 facet joints were injected
in a systematic fashion from caudal to cranial. A sterile dressing was applied. The patient tolerated the
procedure well with no complications and was transferred to recovery in good condition.
Answer: 64493-50,64494-50.
Page 1
, Question 4: 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?
Answer: 64885, 69990, S04.51XA.
Question 5: 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?
Answer: 64831, 64832.
Question 6: A patient receives a paravertebral facet joint injection at three levels on both sides of the
lumbar spine using fluoroscopic guidance for lumbar pain
Answer: 64493-50, 64494-50, 64495-50, M54.5.
Question 7: A 47 year-old female presents to the OR for a partial corpectomy to three thoracic
vertebrae. One surgeon performs the transthoracic approach while another surgeon performs the three
vertebral nerve root decompressions necessary. How should each provider involved code their portion
of the surgery?
Answer: 63085-62, 63086-62 x 2.
Question 8: A patient with primary hyperparathyroidism undergoes parathyroid sestamibi (nuclear
medicine scan) and ultrasound and is found to have only one diseased parathyroid. A minimally
invasive parathyroidectomy is performed. What CPT® and ICD-10-CM codes are reported for the
surgery?
Answer: 60500, E21.0.
Question 9: 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?
Answer: 64493-50, 64494-50.
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with Correct Answers (Grade A+)
Question 1: A 37 year-old has multilevel lumbar degenerative disc disease and is coming in for an
epidural injection. Localizing the skin over the area of L5-S1, the provider uses the transforaminal
approach. The spinal needle is inserted and the patient experienced paresthesia in her left lower
extremities. The anesthetic drug is injected into the epidural space. What CPT® code(s) is/are reported
for this procedure?
Answer: 64483.
Question 2: Operative Report PROCEDURE: Left L3-L4 peri-articular paravertebral facet joint
injection. PATIENT HISTORY: The patient is a 67 year-old woman referred by Dr. X for repeat
diagnostic/therapeutic spinal injection procedure. She is about 1 1/2 years status post lumbar
decompression for stenosis. Two weeks ago she underwent an interarticular left L4-L5 paravertebral
facet joint injection. She had no relief of symptoms from that injection. TECHNIQUE: The patient was
positioned prone and the skin was prepped and draped in the usual sterile fashion. The skin and
underlying soft tissues were anesthetized with 3 cc of 1% lidocaine. Due to the advanced degenerative
changes, the left L3-L4 paravertebral facet joint could not be distinctly visualized fluoroscopically,
despite trying numerous angles. This was explained to the patient who wished to proceed with the
injection. A 22-gauge 6-inch spinal needle was advanced toward the region of the left L3- L4
paravertebral facet joint under fluoroscopic guidance. Injection of 0.5 cc of Isovue 200 contrast showed
the needle was not in an intravascular location. Intra-articular placement could not be confirmed and
the injection was presumed to be peri-articular. 2 cc containing equal parts preservative free 2%
Lidocaine plus Depo-Medrol (80 mg per ml) was injected. The patient reported injection of medication
produced discomfort in the region of her usual left low back pain. Immediately following the
procedure, upon standing up from the procedure table, she reported her pain was a little bit better.
What CPT® code(s) is/are reported for this procedure?
Answer: 64493.
Question 3: PROCEDURES PERFORMED:
1. Bilateral facet joint injections, L4-L5
2. Bilateral facet joint injections, L5-S1.
3. Fluoroscopy. TECHNIQUE: The AP view was aligned with the proper tilt so that the end plates for the
desired levels were perpendicular. The AP image showed the sacrum and the L5 spinous process. Manual
palpation located the sacral hiatus. The 6 inch, 20 gauge needle with a slight volar bend was inserted using
fluoroscopic into each facet joint under AP image. The bilateral L4-L5, and L5-S1 facet joints were injected
in a systematic fashion from caudal to cranial. A sterile dressing was applied. The patient tolerated the
procedure well with no complications and was transferred to recovery in good condition.
Answer: 64493-50,64494-50.
Page 1
, Question 4: 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?
Answer: 64885, 69990, S04.51XA.
Question 5: 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?
Answer: 64831, 64832.
Question 6: A patient receives a paravertebral facet joint injection at three levels on both sides of the
lumbar spine using fluoroscopic guidance for lumbar pain
Answer: 64493-50, 64494-50, 64495-50, M54.5.
Question 7: A 47 year-old female presents to the OR for a partial corpectomy to three thoracic
vertebrae. One surgeon performs the transthoracic approach while another surgeon performs the three
vertebral nerve root decompressions necessary. How should each provider involved code their portion
of the surgery?
Answer: 63085-62, 63086-62 x 2.
Question 8: A patient with primary hyperparathyroidism undergoes parathyroid sestamibi (nuclear
medicine scan) and ultrasound and is found to have only one diseased parathyroid. A minimally
invasive parathyroidectomy is performed. What CPT® and ICD-10-CM codes are reported for the
surgery?
Answer: 60500, E21.0.
Question 9: 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?
Answer: 64493-50, 64494-50.
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