Cardiology Coding Alert

Question: I’m new to coding and was wondering if you could explain the proper use for modifier 66?

Maine Subscriber

Answer: In some cases, your cardiologist may perform a procedure as part of a surgical team, in which case you would use modifier 66 (Surgical team).

“Under some circumstances, highly complex procedures (requiring the concomitant services of several physicians or other qualified health care professionals, often of different specialties, plus other highly skilled, specially trained personnel, various types of complex equipment) are carried out under the “surgical team” concept, according to the CPT^® guidelines.

Caution: Before you append modifier 66, you must ensure that the CPT^® code is modifier 66-approved. You should refer to the Medicare Physician Fee Schedule Database (MPFSDB) to determine if CPT^® modifier 66 is applicable to a particular surgical CPT^® code.

If you find a “1” in the TEAM SURG column, Medicare may allow modifier 66 with supporting documentation that establishes medical necessity for the surgical team. If you find “2” in the TEAM SURG column, Medicare will permit modifier 66 with that code.

Documentation: When you are coding for team surgery, the medical record must show medical necessity for having a team of surgeons working together, because team surgeries are paid for on a “by-report” basis.

Physicians must provide details in their documentation describing the procedure performed and stating that they were part of a team. Each provider reports the same procedure code(s) with modifier 66 attached. This tells the payer that the amount for the procedure should be divvied up between a team of providers instead of being paid to just one.