Ophthalmic Coding Specialist Practice Test

What is the primary payment policy for codes 66840 through 66940?

1. Payment is per patient visit

2. Payment is only for surgeries performed in the ASC

3. Payment is per eye

4. Payment is based on the type of anesthesia used

The correct answer is: Payment is per eye

The primary payment policy for the codes ranging from 66840 through 66940 is structured around the concept of payment per eye. These codes correspond to various surgical procedures performed on the eye, specifically cataract surgeries, which often require separate billing for each eye if both eyes are treated during the same session or at different times. This per-eye payment approach reflects the unique nature of ocular procedures where the complexity and cost can vary between eyes. Even if a surgery involves both eyes in a single operative session, the payment system accounts for each eye as a distinct procedure. In contrast, payment per patient visit typically applies to general office visits rather than surgical procedures. The notion that payment is restricted to surgeries conducted in Ambulatory Surgical Centers (ASC) does not accurately encompass the broader scope of where these procedures can be performed, as they may also be carried out in hospital outpatient settings. Lastly, although the type of anesthesia used might influence the overall cost of surgery, it does not determine the foundational payment structure associated with these specific codes. Understanding this payment policy is essential for accurate coding and billing in ophthalmic care.