AAPC CHAPTER 14 PRACTICAL APPLICATIONS
LATEST UPDATED QUESTIONS AND ANSWERS
(2025 -2026 ) GUARANTEED SUCCESS
Be kind to yourself and keep practising!
,OPERATIVE FINDINGS: Tight stenosis at L4-5 from ligament hypertrophy and facet
arthropathy.
OPERATIVE INDICATIONS: The patient is a 51‑year‑old gentleman. He has had ongoing
lower extremity pain with numbness and tingling on the right side more so than the
left side. He has had paresthesias. He has had progressive loss of strength. He has had
very little back pain, however. The patient is brought to the operating room for
operative decompression following an MRI scan that showed tight spinal stenosis at
L4-5, having failed conservative measures to date.
DESCRIPTION OF PROCEDURE: The patient was given 1 gm of Kefzol preoperatively.
He was taken to the operating room where he underwent general endotracheal tube
anesthesia without complications. All appropriate anesthetic monitors and lines
were placed. He was placed prone onto a Wilson frame which was padded in the
usual fashion. All pressure points were checked and padded appropriately. The
patient's back was then outlined with a marking pen through the L4-5 level in a
vertical direction. He was then prepped using Prevail solution and allowed to dry. He
was draped using sterile technique. Marcaine 0.25% with 1:200,000 units of
epinephrine was instilled in the proposed incision for a total of 10 cc of injection.
Using a #10 blade scalpel, a vertical midline incision was made. The soft tissues were
dissected down to the thoracolumbar fascia using Bovie coagulation. The fascia was
incised on the right hand side and the paraspinal muscles were stripped off the
lamina and spinous processes of L4 and L5 on the right. A self-retaining Taylor
retractor was placed into the wound and intraoperative fluoroscopy revealed the L4-
5 level. The soft tissue in the interlaminar space was then resected with a rongeur.
The ligamentum flavum was resected with Kerrison punches and cervical curets. The
laminotomy was performed on the superior aspect of L5 and the undersurface of L4.
The laminotomy was taken out to the medial edge of the right pedicle. A
foraminotomy was performed with a #3 Kerrison punch for the exiting right L5 nerve
, root. The lateral recess was now decompressed. The disc was inspected and found
not to be ruptured. We then decompressed the patient's left side by slightly
depressing the thecal sac with cottonoids and under-cutting the interspinous
ligament with Kerrison punches so that the right lateral recess was also
decompressed from overgrowth of the ligamentum flavum. The wound was
copiously irrigated using warm bacitracin solution. Depo-Medrol 40 mg in 1 cc was
placed epidurally. A piece of Gelfoam was placed over the laminotomy defect to try
to preserve the epidural space, and the wound was ready for closure. During all
areas of closure, bacitracin irrigation was used in copious amounts. The fascia was
closed with #0 Vicryl in an interrupted fashion. The subcutaneous tissue was closed
with #3‑0 Vicryl in an interrupted fashion. The skin was closed with #4‑0 Vicryl in an
interrupted fashion to the subcuticular space. Steri-Strips were placed on the
wound. A sterile dressing was placed. The patient was taken to the recovery room in
stable condition with sponge and needle counts correct times three.
What are the CPT® and ICD-10-CM codes reported?
Give this one a go later!
64493-50, 64494-50, M51.36 63042-LT, M54.16, M48.07
60220, E04.1 63030-50, M48.061
Don't know?
2 of 10
LATEST UPDATED QUESTIONS AND ANSWERS
(2025 -2026 ) GUARANTEED SUCCESS
Be kind to yourself and keep practising!
,OPERATIVE FINDINGS: Tight stenosis at L4-5 from ligament hypertrophy and facet
arthropathy.
OPERATIVE INDICATIONS: The patient is a 51‑year‑old gentleman. He has had ongoing
lower extremity pain with numbness and tingling on the right side more so than the
left side. He has had paresthesias. He has had progressive loss of strength. He has had
very little back pain, however. The patient is brought to the operating room for
operative decompression following an MRI scan that showed tight spinal stenosis at
L4-5, having failed conservative measures to date.
DESCRIPTION OF PROCEDURE: The patient was given 1 gm of Kefzol preoperatively.
He was taken to the operating room where he underwent general endotracheal tube
anesthesia without complications. All appropriate anesthetic monitors and lines
were placed. He was placed prone onto a Wilson frame which was padded in the
usual fashion. All pressure points were checked and padded appropriately. The
patient's back was then outlined with a marking pen through the L4-5 level in a
vertical direction. He was then prepped using Prevail solution and allowed to dry. He
was draped using sterile technique. Marcaine 0.25% with 1:200,000 units of
epinephrine was instilled in the proposed incision for a total of 10 cc of injection.
Using a #10 blade scalpel, a vertical midline incision was made. The soft tissues were
dissected down to the thoracolumbar fascia using Bovie coagulation. The fascia was
incised on the right hand side and the paraspinal muscles were stripped off the
lamina and spinous processes of L4 and L5 on the right. A self-retaining Taylor
retractor was placed into the wound and intraoperative fluoroscopy revealed the L4-
5 level. The soft tissue in the interlaminar space was then resected with a rongeur.
The ligamentum flavum was resected with Kerrison punches and cervical curets. The
laminotomy was performed on the superior aspect of L5 and the undersurface of L4.
The laminotomy was taken out to the medial edge of the right pedicle. A
foraminotomy was performed with a #3 Kerrison punch for the exiting right L5 nerve
, root. The lateral recess was now decompressed. The disc was inspected and found
not to be ruptured. We then decompressed the patient's left side by slightly
depressing the thecal sac with cottonoids and under-cutting the interspinous
ligament with Kerrison punches so that the right lateral recess was also
decompressed from overgrowth of the ligamentum flavum. The wound was
copiously irrigated using warm bacitracin solution. Depo-Medrol 40 mg in 1 cc was
placed epidurally. A piece of Gelfoam was placed over the laminotomy defect to try
to preserve the epidural space, and the wound was ready for closure. During all
areas of closure, bacitracin irrigation was used in copious amounts. The fascia was
closed with #0 Vicryl in an interrupted fashion. The subcutaneous tissue was closed
with #3‑0 Vicryl in an interrupted fashion. The skin was closed with #4‑0 Vicryl in an
interrupted fashion to the subcuticular space. Steri-Strips were placed on the
wound. A sterile dressing was placed. The patient was taken to the recovery room in
stable condition with sponge and needle counts correct times three.
What are the CPT® and ICD-10-CM codes reported?
Give this one a go later!
64493-50, 64494-50, M51.36 63042-LT, M54.16, M48.07
60220, E04.1 63030-50, M48.061
Don't know?
2 of 10
