Ophthalmic Coding Specialist Practice Test

For CPT code 11440, how is the payment structured?

1. Per lesion

2. Per eye

3. Per session

4. Per referral

The correct answer is: Per session

The payment structure for CPT code 11440 is designed to be per lesion. This code specifically pertains to the excision of a benign skin lesion, and when billing for this type of procedure, healthcare providers are compensated for each individual lesion removed during a session. Billing per lesion allows for a clearer understanding of the procedure's complexity and the resources involved, as the payment is tied directly to the quantity of lesions addressed rather than arbitrary units such as sessions or referrals. Each excision is considered a distinct service, justifying separate payments for multiple lesions treated within the same encounter, making the billing more accurate and reflective of the care provided. Per eye would apply in situations involving procedures specifically targeting the optical limits of each eye, often referring to surgeries and evaluations where individual eye assessments are billed separately. Per session typically does not apply in contexts that focus on the quantity of lesions, as it implies a fixed rate for all services rendered in a single visit regardless of the specifics of care. Per referral also does not relate to the excision of lesions but rather suggests a payment structure associated with patient referrals, which does not correspond to the specific action of excising lesions as indicated by CPT code 11440.