Ophthalmic Coding Specialist Practice Test

When is CPT code 66825 payable?

1. Only in the outpatient setting

2. During the global period of any surgery

3. In the ASC or hospital setting

4. When performed in a private practice

The correct answer is: In the ASC or hospital setting

CPT code 66825 is associated with the procedure known as "laser peripheral iridotomy." This specific code is typically payable when the procedure is performed in an Ambulatory Surgical Center (ASC) or hospital setting. Payment policies for various procedures often differ based on the site of service due to factors like resource utilization and facility fees. Performing the procedure in an ASC or hospital allows for the necessary equipment and support staff to be available for patient safety and effective treatment. These settings are equipped for outpatient procedures that require a more controlled environment than a private practice might offer. It is also worth noting that certain codes may have restrictions on the settings in which they may be performed and reimbursed. In contrast, other settings, such as private practice, might not qualify for payment under the same code due to differing equipment and staffing capacities. Therefore, understanding the payment policies associated with specific codes in relation to the healthcare setting is essential for proper coding and billing practices.