General Surgery Coding Alert

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.