Understanding Modifier 66: Team Surgery
Introduction
In the realm of complex medical procedures, collaboration between multiple surgeons of diverse specialties is often crucial for optimal patient outcomes. Modifier 66 in medical coding plays a vital role in recognizing and appropriately reimbursing such collaborative efforts, known as “team surgery.” This article aims to guide healthcare providers on the correct use of modifier 66, ensuring accurate billing and fair compensation for team-based surgical care.
Defining Team Surgery
Team surgery involves more than two surgeons of different specialties working together to perform a single, highly intricate procedure. Each surgeon contributes their unique expertise to distinct aspects of the operation, ensuring comprehensive and specialized care for the patient. It’s important to distinguish this from sequential procedures performed by surgeons of the same specialty, where each surgeon bills separately for their portion. In such cases, modifier 62 for assistant surgeon might be applicable.
When to Use Modifier 66
The use of modifier 66 is appropriate when the following criteria are met:
- Involvement of multiple, specialized surgeons: A minimum of three surgeons with distinct specialties is required for team surgery.
- Highly complex procedure: The procedure being performed necessitates the combined expertise of multiple specialists due to its complexity and potential risks.
- Collaborative effort: Each surgeon actively contributes to the procedure, working together seamlessly as a team.
- Medicare Physician Fee Schedule (MPFS) Indicator: The procedure code in question has a “T” indicator of 1 or 2 in the MPFS, signifying its eligibility for team surgery reimbursement.
Billing Guidelines
- All surgeons involved in the team surgery must append modifier 66 to the same CPT code representing the primary procedure.
- Additional procedures: If individual surgeons perform additional procedures specific to their specialties within the same operative session, they can be billed separately with appropriate modifiers (e.g., primary surgeon or assistant surgeon) and subject to multiple surgery reduction rules.
- Team surgery reimbursement: The total reimbursement for the team is 150% of the fee schedule rate for the procedure, divided equally among the participating surgeons. No additional assistant surgeon claims are allowed for procedures billed with modifier 66.
Important Considerations
- Documentation: Thorough medical records documenting the necessity of team surgery and the specific contributions of each surgeon are crucial for proper claim processing and medical review.
- Payer-specific policies: While the information provided aligns with general Medicare guidelines, remember that different insurance companies might have varying policies regarding team surgery coding and reimbursement. Always consult the specific payer’s guidelines for accurate information.
- Regular updates: Medical coding regulations and guidelines are subject to change. Healthcare providers need to stay updated on the latest information to ensure accurate and compliant billing practices.
Modifier 66 plays a significant role in recognizing and valuing the collaborative efforts of surgical teams tackling highly complex procedures. By understanding the appropriate use of this modifier and adhering to relevant guidelines, healthcare providers can ensure accurate billing practices and fair compensation for team-based surgical care, ultimately benefiting both providers and patients.
We hope this article has given you all the necessary information to use modifier 66 appropriately. If you are unsure and need help in medical billing for your practice, you can always contact us. PrimeCare has an experienced billing and coding team that uses exact modifiers to bring accurate insurance reimbursement. Contact us today to learn more about our medical billing services.
References:
The American Medical Association (AMA) holds the copyright for the Current Procedural Terminology (CPT®) codes and their associated modifiers, including those mentioned in this article. The use of these codes and modifiers is governed by the AMA’s Current Procedural Terminology (CPT®) Coding Rules and the Healthcare Common Procedure Coding System (HCPCS) guidelines.
