Ophthalmic Coding Specialist Practice Test

Why is CPT code 65273 not payable in an ASC?

1. It requires hospitalization

2. It is not an accepted code

3. It is a cosmetic procedure

4. There is no patient demand

The correct answer is: It requires hospitalization

CPT code 65273 refers to a specific procedure related to the removal of foreign bodies from the eye, typically performed in a surgical setting. The reason this code is not payable in an Ambulatory Surgery Center (ASC) is that it often necessitates hospitalization due to the need for more extensive post-operative care or monitoring that may exceed the capabilities or limits of an ASC. Certain procedures, particularly those involving complications or higher risks, are better suited for a hospital environment where more comprehensive medical support is available. Therefore, when a procedure has been determined to require hospitalization, it is not considered appropriate for ASC billing, which is designed for less complex surgical cases that can safely be done on an outpatient basis. This context helps clarify why the choice indicating the need for hospitalization is the correct one, as it encompasses the regulatory and clinical guidelines dictating where specific procedures can be performed based on their complexity and required oversight.