AAPC CHAPTER 14 EXAMINATION STUDY
SHEET 2026 QUESTIONS WITH DETAILED
SOLUTIONS
◉64483. Answer: 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?
◉64493. Answer: 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?
◉64493-50 ,64494-50. Answer: 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
SHEET 2026 QUESTIONS WITH DETAILED
SOLUTIONS
◉64483. Answer: 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?
◉64493. Answer: 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?
◉64493-50 ,64494-50. Answer: 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
