Cardiology Coding Alert

Question: The cardiologist performs a left heart cath. An interventional cardiologist is called in on the same day to perform a stent. Is it appropriate to use modifier -66 (surgical team)?

Massachusetts Subscriber

Answer: No. In this case, the two cardiologists can bill separately for the procedures they performed. Based on the limited information provided, the interventional cardiologist would report 92980 (Transcatheter placement of an intracoronary stent[s], percutaneous, with or without other therapeutic intervention, any method; single vessel) only, and the cardiologist would report 93510 (Left heart catheterization, retrograde, from the brachial artery, axillary artery or femoral artery; percutaneous) and the appropriate injection and supervision and interpretation (S&I) codes.

Team surgery, which is rarely performed in cardiology, refers to operations that require two or more surgeons of different specialties, performing different procedures that are identified by different CPT codes. Usually, different body areas or organs are involved. When team surgery claims are accepted, they are reimbursed the same as individual surgery.

Most if not all procedures typically performed by cardiologists cannot be reported as components of team surgery, according to Medicare's Physician Fee Schedule Relative Value File. The codes all have "0" indicators in field N of the fee schedule, which means team surgery does not apply.