General Surgery Coding Alert

Question: Our general surgeon worked as part of a surgical team for a liver transplant in which he made the initial abdominal midline incision and participated in the left lobe hepatectomy, including maintaining hemostasis and drainage, while a transplant surgeon inserted the cadaver donor liver, connecting it to the hepatic artery, vein, and bile ducts. How should we code our surgeon’s work, and should we use modifier 66?

Florida Subscriber

Answer: The case appears to be two surgeons rather than a surgical team. Your surgeon participated in the hepatectomy, so you should bill his work as 47125 (Hepatectomy, resection of liver; total left lobectomy) with modifier 62 (Two surgeons).

The transplant surgeon will also bill 47125 with modifier 62. Additionally, the transplant surgeon will bill the liver insertion as 47135 (Liver allotransplantation, orthotopic, partial or whole, from cadaver or living donor, any age). Depending on documentation, both surgeons may sometimes bill the transplant, too, in which case both would bill the code with modifier 62.

Not 66: This is not a case for modifier 66 (Surgical team), because you document just two surgeons. You should use modifier 66 only when more than two surgeons participate in a single procedure that CPT^® describes with one code. In the case of liver transplant, CPT® provides one code for the hepatectomy, and a separate code for the liver transplantation.

Also, 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. Your scenario doesn’t indicate any of those details. In fact, very few procedures currently require or are approved for team surgery coverage, reportable with modifier 66.