General Surgery Coding Alert
Check with Payer Before Applying Modifier -66
Question: Are there any special requirements for appending modifier -66? Maine Subscriber Answer: Apply modifier -66 (Surgical team) when a team of surgeons (three or more) works together to complete a procedure reported using a single CPT code. The requirements for modifier -66 are similar to those for modifier -62 (Two surgeons). Each physician bills independently, and each provides his or her own operative report and documentation. Team surgeries are uncommon and involve complex procedures such as organ transplants or separation of cojoined twins, for instance. Payers will review modifier -66 claims on a case-by-case basis. Reimbursement among the physicians is determined at the time of review, based on documentation provided. Many payers maintain a (short) list of procedures for which modifier -66 is justified. If possible, ask your payer prior to surgery if it has any special instructions. If several surgeons work together during the same operative session but report distinct procedures (that is, nonbundled procedures with their own CPT codes), modifier -66 is not needed. Similarly, two surgeons working together with the aid of a surgical assistant do not qualify as a surgical team as defined by modifier -66. The team must consist of three or more primary surgeons.
General Surgery Coding Alert
- Cut Out the Confusion of Lesion Excisions
For 2003, CPT significantly revises its guidelines for reporting excision of benign (11400-11471) and malignant [...] - Repairs with Lesion Excision Arent an Open-and-Shut Case
Physicians and coders should remember that in most cases, lesion excision will include closure, depending [...] - Watch Incision versus Margins When Calculating Diameter
When calculating excision diameter, be careful not to confuse the length of the incision with [...] - You Be the Coder:
Watch Dx and Modifiers with Thrombectomy
Test your coding knowledge. Determine how you would code this situation before looking at the [...] - Documentation Requirements Ease for Teaching Physicians
By Eric Sandham, CPC Under new Medicare rules, teaching physicians will find it easier to [...] - Reader Question:
Use Modifier -78 with Wound Dehiscence
Question: The wound repair article in your December 2002 issue failed to mention wound dehiscence [...] - Reader Question:
Check with Payer Before Applying Modifier -66
Question: Are there any special requirements for appending modifier -66? Maine Subscriber Answer: Apply modifier [...] - Reader Question:
Private Payers May Reimburse Telephone Codes
Question: Our physician spent 20 minutes during office hours on the phone providing advice and [...] - Reader Question:
Conscious Sedation
Question: I have read that conscious sedation by a physician performing an endoscopy is not [...] - Reader Question:
When Converting, Report Only the Open Procedure
Question: How should I code if the surgeon must convert to an open procedure during [...] - Keep Tabs on Surgeons Whereabouts to Avoid Incident-To Snafus
A surgeon's phone call is not enough to allow a surgery practice to bill "incident-to" [...] - CMS Allows Incident-To Billing for Shared E/M Services
Thanks to a recent CMS revision to its E/M rules, general surgery practices stand to [...] - Medical Necessity Is Critical for 99211 Reimbursement
Do patients come into the office for blood pressure checks or other brief E/M services [...] - Test Yourself:
A 99211 Coding Checkup
How much do you really know about when to report code 99211? Take the following [...] - Reader Question:
99211 Isnt Just for Nurses
Question: We employ a physician assistant (PA) who performs all levels of E/M services. We [...] - Reader Question:
Use HCPCS Modifiers to Report PA Surgery Assist
Question: When a physician assistant (PA) assists in surgery on an outpatient basis, does this [...] - Reader Question:
Physician Oversight Required for Critical Care
Question: Is it appropriate to include the time that our PA spends with a patients [...] - Reader Question:
Dual Diagnosis Presents Incident-To Options
Question: A physician assistant (PA) or a nurse practitioner (NP) is treating a patient incident-to [...] - Reader Question:
Bill Incident-To the Resident Doc
Question: One of our doctors treated a patient for an abscess at the site of [...]
