Assign Neurosurgical Codes - Certified Professional Coder CPC

1. A neurosurgeon performs a craniotomy and excises a glioblastoma from the right parietal lobe (supratentorial). Which CPT® code covers craniotomy for excision of a supratentorial brain tumor?
   Answer: 61510 CPT® 61510 describes craniotomy or craniectomy for excision of a supratentorial brain tumor — the correct code for a general supratentorial tumor resection that is not a meningioma or brain stem tumor. Code 61512 is specifically for excision of a supratentorial meningioma; using it for a glioblastoma is incorrect. Code 61518 describes excision of an infratentorial (e.g., cerebellar) tumor; the parietal lobe is supratentorial. Code 61521 describes excision of a brain stem tumor, which is a distinct anatomic location from the parietal lobe. The tumor location and histologic type determine the correct code within this range.
2. A surgeon performs open neuroplasty of the ulnar nerve at the elbow for cubital tunnel syndrome. Which CPT® code describes neuroplasty of the ulnar nerve at the elbow?
   Answer: 64718 CPT® 64718 describes neuroplasty (decompression and/or transposition) of the ulnar nerve at the elbow, which is the definitive surgical treatment for cubital tunnel syndrome. Code 64708 describes neuroplasty of a major peripheral nerve not otherwise specified — a less specific code that should not be used when a named nerve code (64718) exists for the same procedure. Code 64719 describes neuroplasty of the ulnar nerve at the wrist, not the elbow; the anatomic level matters because the nerve is compressed at different sites in these two conditions. Code 64721 describes open carpal tunnel release of the median nerve, which involves a different nerve and a different location entirely.
3. A physician injects a corticosteroid into the left L3-L4 zygapophyseal (facet) joint under fluoroscopic guidance. Which CPT® code is reported for a lumbar facet joint injection with imaging guidance?
   Answer: 64493 CPT® 64493 describes a diagnostic or therapeutic injection into a paravertebral facet (zygapophyseal) joint or the nerves innervating it at the lumbar or sacral level, single level, with imaging guidance. Code 64490 describes the same facet joint injection but at the cervical or thoracic level; L3-L4 is lumbar. Code 64479 describes a transforaminal epidural injection at the cervical or thoracic level — a different anatomic target (the epidural space via the foramen) rather than the facet joint itself. Code 64483 describes a transforaminal epidural injection at the lumbar or sacral level — also a different target than the facet joint. Distinguishing facet joint injections (64490/64493) from transforaminal epidural injections (64479/64483) is a high-frequency error in spine coding.
4. A spine surgeon performs a single-segment lumbar laminectomy with facetectomy and foraminotomy for lumbar spinal stenosis. Which CPT® code is reported?
   Answer: 63047 CPT® 63047 describes laminectomy with facetectomy and foraminotomy at a single lumbar vertebral segment — the correct code when all three components are performed together for lumbar stenosis. Code 63005 describes laminectomy without facetectomy or foraminotomy; it would be incorrect here because both additional steps were performed. Code 63030 is a laminotomy (hemilaminectomy) for herniated disc, not for stenosis requiring all three decompressive steps. Code 63046 is the same three-component laminectomy as 63047 but at the thoracic level, not the lumbar level.
5. A pain management physician performs a lumbar interlaminar epidural steroid injection without imaging guidance. Which CPT® code is reported?
   Answer: 62322 CPT® 62322 describes a lumbar or sacral interlaminar epidural injection without imaging guidance (fluoroscopy or CT). Code 62323 is the same lumbar/sacral approach but with imaging guidance — the most common distractor because many lumbar epidurals are done under fluoroscopy. Codes 62320 and 62321 apply to the cervical or thoracic level, not the lumbar level. The two axes that distinguish these four codes are spinal level (lumbar/sacral vs. cervical/thoracic) and imaging status (with vs. without).
6. A surgeon performs a hemilaminectomy with partial facetectomy, foraminotomy, and disc excision at L4-L5 for a herniated disc. Which CPT® code is reported?
   Answer: 63030 CPT® 63030 describes laminotomy (hemilaminectomy) at a single lumbar interspace, including partial facetectomy, foraminotomy, and/or excision of a herniated disc — the standard posterior approach for single-level lumbar disc herniation. Code 63005 describes laminectomy at 1 or 2 lumbar segments for decompression without facetectomy or discectomy, which is appropriate for stenosis rather than a focal herniated disc. Code 63020 describes the same laminotomy procedure but at the cervical level; L4-L5 is lumbar, not cervical. Code 63047 describes laminectomy with facetectomy and foraminotomy for spinal stenosis at a single lumbar segment — it is more extensive than a laminotomy and does not include disc excision as a primary indication.
7. A surgeon places a percutaneous neurostimulator electrode array in the epidural space for spinal cord stimulation. Which CPT® code describes percutaneous epidural electrode implantation?
   Answer: 63650 CPT® 63650 describes percutaneous implantation of a neurostimulator electrode array in the epidural space — the correct code for spinal cord stimulation when the electrode is placed percutaneously. Code 63655 describes open implantation of a plate or paddle electrode via laminectomy — the approach (open vs. percutaneous) and electrode type (paddle vs. wire array) distinguish it from 63650. Code 63685 describes insertion of the spinal neurostimulator pulse generator or receiver, which is a separate, additionally reportable code. Code 64555 describes percutaneous implantation of an electrode array for a peripheral nerve, not the epidural spinal cord.
8. A physician injects a local anesthetic into the greater occipital nerve for the treatment of occipital neuralgia. Which CPT® code is reported?
   Answer: 64405 CPT® 64405 covers injection, anesthetic agent, greater occipital nerve — the dedicated code for an occipital nerve block. Because 64405 exists as a named nerve code, it must be used in preference to the non-specific code 64450. Code 64450 covers injection of other peripheral nerves or branches not specifically named elsewhere in CPT® and would only be appropriate when no specific code exists for the nerve being injected. Code 64400 describes injection of the trigeminal nerve or one of its named divisions — a different cranial nerve in a different anatomic location. Code 64413 describes injection of the cervical plexus, which provides sensory and motor innervation to the neck and is distinct from the occipital nerve. When a named CPT® code exists for the specific nerve injected, it always takes precedence over 64450.
9. A pain management physician performs a transforaminal epidural steroid injection at the lumbar level, single level, under fluoroscopic guidance. Which CPT® code is reported?
   Answer: 64483 CPT® 64483 describes a transforaminal epidural injection at the lumbar or sacral level, single level, with imaging guidance (fluoroscopy or CT). Code 64479 describes the same transforaminal technique but at the cervical or thoracic level — the spinal level is the key differentiator between 64479 and 64483. Code 62323 describes an interlaminar (not transforaminal) lumbar epidural with imaging guidance; interlaminar and transforaminal are different approaches to the epidural space. Code 64493 describes an injection into the paravertebral facet (zygapophyseal) joint itself, not a transforaminal epidural injection.
10. A physician performs a cervical interlaminar epidural steroid injection at C6-C7 under fluoroscopic guidance. Which CPT® code is reported?
    Answer: 62321 CPT® 62321 describes an interlaminar epidural injection at the cervical or thoracic level with imaging guidance (fluoroscopy or CT). Code 62320 describes the same cervical/thoracic interlaminar epidural approach but without imaging guidance — the presence of fluoroscopy elevates the code from 62320 to 62321. Code 62323 describes a lumbar or sacral interlaminar epidural with imaging guidance; the C6-C7 level is cervical, not lumbar. Code 64479 describes a transforaminal (not interlaminar) epidural injection at the cervical or thoracic level with imaging guidance — a different approach to the epidural space entirely. The spinal level and imaging status are the two critical axes for distinguishing 62320 through 62323.
11. A microsurgeon performs primary suture repair of the ulnar nerve at the wrist following a laceration. Which CPT® code describes suture of the ulnar nerve at or below the wrist?
    Answer: 64836 CPT® 64836 describes suture (primary repair) of the ulnar nerve at or below the wrist — the correct code for a laceration repair of the ulnar nerve at this level. Code 64719 describes neuroplasty (decompression or release) of the ulnar nerve at the wrist, which is a different procedure from primary suture repair after a laceration. Code 64718 describes neuroplasty of the ulnar nerve at the elbow (for cubital tunnel syndrome) — a different nerve level and a different procedure type. Code 64831 describes suture of a digital nerve in the hand or foot, which is a smaller nerve than the ulnar nerve proper. The distinction between neuroplasty and suture repair, and between anatomic levels, is critical when coding ulnar nerve procedures.
12. A surgeon harvests a single-strand nerve graft measuring 5 cm in length and uses it to repair a nerve gap in the upper arm. Which CPT® code is reported?
    Answer: 64893 CPT® 64893 covers nerve graft, single strand, arm or leg; more than 4 cm in length — the correct code for a single-strand graft in an arm or leg nerve when the graft exceeds 4 cm. Code 64898 covers a multiple-strand (cable) nerve graft for the arm or leg, more than 4 cm — the strand count (single vs. cable) is the critical differentiator between 64893 and 64898. Code 64891 covers a single-strand nerve graft for the hand or foot, more than 4 cm — the anatomic site (arm/leg vs. hand/foot) distinguishes it from 64893. Code 64895 covers a multiple-strand (cable) graft for the hand or foot. The correct code is determined by two independent axes: anatomic site (arm/leg vs. hand/foot) and strand count (single-strand vs. multi-strand cable).
13. A 6-year-old child with communicating hydrocephalus undergoes placement of a new ventriculoperitoneal shunt. Which CPT® code describes creation of a shunt to the peritoneal cavity?
    Answer: 62223 CPT® 62223 describes creation of a ventriculoperitoneal, ventriculopleural, or other terminus shunt — the correct code when the distal end of the shunt terminates in the peritoneum. Code 62220 describes creation of a ventriculoatrial or ventriculojugular shunt, where the terminus is a cardiac chamber or jugular vein; the terminus distinguishes it from 62223. Code 62225 covers replacement or irrigation of a ventricular catheter in an existing shunt system, not creation of a new shunt. Code 62230 covers replacement or revision of an obstructed shunt, not a new shunt placement.
14. A surgeon performs an endoscopic carpal tunnel release on a patient with carpal tunnel syndrome. Which CPT® code describes endoscopic carpal tunnel release?
    Answer: 29848 CPT® 29848 describes endoscopic carpal tunnel release and is located in the Musculoskeletal section. Code 64721 describes open (not endoscopic) carpal tunnel release (median nerve neuroplasty at the carpal tunnel) and is found in the Nervous System section. The surgical approach — endoscopic versus open — is the key differentiator; when the surgeon uses endoscopic technique, 29848 is correct. Codes 64722 and 64726 describe decompression of an unspecified nerve and plantar digital nerve, respectively, and do not apply to carpal tunnel release.
15. A regional anesthesiologist performs a single-injection block of the sciatic nerve for below-knee surgery. Which CPT® code describes sciatic nerve injection?
    Answer: 64445 CPT® 64445 describes a single-injection block of the sciatic nerve with an anesthetic agent — the correct code when the sciatic nerve is the specifically targeted structure. Code 64415 describes injection of the brachial plexus, which is an upper extremity nerve structure and not relevant to a below-knee procedure. Code 64430 describes injection of the pudendal nerve, which provides sensation to the perineum and is not the sciatic nerve. Code 64447 describes a femoral nerve block by continuous infusion catheter — a different nerve (femoral, not sciatic) and a different delivery method (catheter, not single injection). When a specific named nerve is injected, the named nerve code (64445) is always preferred over the general code 64450.
16. A 45-year-old patient with suspected subarachnoid hemorrhage undergoes a lumbar puncture for diagnostic CSF analysis. Which CPT® code describes a diagnostic spinal puncture?
    Answer: 62270 CPT® 62270 describes a spinal puncture (lumbar puncture) performed specifically for diagnostic purposes, such as CSF cell count, protein, glucose, or xanthochromia analysis. Code 62272 describes a therapeutic lumbar puncture performed to drain CSF, as in idiopathic intracranial hypertension (pseudotumor cerebri); the intent (diagnostic vs. therapeutic drainage) distinguishes these two codes. Code 62263 describes percutaneous lysis of epidural adhesions over multiple days — a completely different procedure. Code 62268 describes percutaneous aspiration of a spinal cord cyst or syrinx, not a standard lumbar puncture.
17. A neurosurgeon performs a posterior fossa craniectomy and excises a cerebellar tumor (not a cerebellopontine angle or brain stem tumor). Which CPT® code describes excision of an infratentorial brain tumor?
    Answer: 61518 CPT® 61518 describes craniectomy for excision of an infratentorial brain tumor (e.g., cerebellar tumor) — the correct code when the tumor is in the posterior fossa but is not specifically a cerebellopontine angle or brain stem tumor. Code 61510 describes excision of a supratentorial brain tumor; the cerebellum is infratentorial, not supratentorial. Code 61520 describes excision of a cerebellopontine angle (CPA) tumor, which is a specific anatomic subset of infratentorial tumors requiring its own code; the problem states it is not a CPA tumor. Code 61521 describes excision of a brain stem tumor, also specifically carved out from the general infratentorial category. Location within the posterior fossa (general cerebellar vs. CPA vs. brain stem) determines the correct infratentorial tumor code.
18. A spine surgeon performs a percutaneous kyphoplasty at a single lumbar vertebral body for an osteoporotic compression fracture. Which CPT® code is reported?
    Answer: 22514 CPT® 22514 describes percutaneous vertebral augmentation (kyphoplasty) at a single lumbar vertebral body — kyphoplasty uses a balloon tamp to restore vertebral height before injecting bone cement. Code 22513 describes the same kyphoplasty procedure but at a single thoracic vertebral body; the lumbar vs. thoracic level distinction separates 22513 from 22514. Codes 22510 and 22511 describe vertebroplasty (not kyphoplasty) at the cervicothoracic and lumbosacral levels, respectively; vertebroplasty involves direct cement injection without a balloon, distinguishing it from kyphoplasty. Both the procedure type (kyphoplasty vs. vertebroplasty) and the spinal level (lumbar vs. thoracic) must be identified to select the correct code.
19. A neurosurgeon performs an anterior cervical discectomy at C5-C6 with decompression and osteophytectomy (single cervical interspace, anterior approach). Which CPT® code is reported?
    Answer: 63075 CPT® 63075 describes discectomy via an anterior approach with decompression at a single cervical interspace, including osteophytectomy — this is the anterior cervical discectomy (ACDF) procedure code. Code 63020 describes a posterior approach (laminotomy) for cervical disc herniation, not an anterior approach. Code 63030 is also a posterior laminotomy but at the lumbar level. Code 63081 describes vertebral corpectomy, which involves removal of a vertebral body — a more extensive anterior procedure than discectomy alone and only appropriate when the body itself is resected.
20. A neurosurgeon inserts a new spinal cord neurostimulator pulse generator for a patient with a previously implanted spinal cord stimulation system. Which CPT® code describes insertion of a spinal neurostimulator pulse generator?
    Answer: 63685 CPT® 63685 describes insertion or replacement of a spinal neurostimulator pulse generator or receiver — the implantable power source that drives a spinal cord stimulation system. Code 63650 describes percutaneous implantation of the epidural electrode array itself; the array and the pulse generator are separately reportable, and only the generator is being placed here. Code 61885 describes insertion of a cranial neurostimulator pulse generator, not a spinal generator. Code 64590 describes insertion of a peripheral or gastric neurostimulator pulse generator. The anatomic system (spinal vs. cranial vs. peripheral) and the component type (electrode array vs. pulse generator) are the key differentiators across the neurostimulator coding family.

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