General Surgery Coding Alert

Question: The general surgeon assisted with a liver transplant procedure as part of a surgical team. He performed the initial midline incision on the abdomen and was involved in the hepatectomy of the left lobe, which included ensuring blood flow control and managing drainage. Meanwhile, the transplant surgeon was responsible for implanting the cadaver donor liver and connecting it to the hepatic artery, vein, and bile ducts. How should we code our surgeon’s work, and should we use modifier 66?

AAPC Forum Participant

Answer: Because you mention only two surgeons, and not an actual surgical team, and your surgeon participated in the hepatectomy, you should bill his portion of the 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 also bill that code with modifier 62.

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

When coding for a surgical team, it’s crucial that the medical documentation demonstrates the medical necessity of multiple surgeons collaborating on the procedure. This is because the payment for team surgeries is determined on a case-by-case basis, often referred to as “by-report” basis. Surgeons are required to include detailed descriptions of the procedures they performed in their documentation and specify their role as part of a surgical team. Each provider should report identical procedure codes, but with the addition of the 66 modifier. This informs the payer that the payment for the procedure should be distributed among multiple providers, rather than being allocated to a single provider. doesn’t indicate any of those details. In fact, very few procedures currently require or are approved for team surgery coverage, which would be reportable with modifier 66.

Take note: According to Terri Brame Joy, MBA, CPC, COC, CGSC, CPC-I, product manager at MRO in Philadelphia, “Modifier 66, once commonly used for comprehensive transplant procedures, is now seldom used due to the segregation of transplant codes into component parts. It may still be applicable in rare, complex pediatric cases requiring expedient work to support patient life.”