Friday, April 30, 2010

Surgical Team Modifier 66

Surgical - 66 Modifier

66   Surgical Team: Under some circumstances, highly complex procedures (requiring the concomitant services of several physicians, often of different specialties, plus other highly skilled, specially trained personnel and various types of complex equipment) are carried out under the “surgical team” concept. Such circumstances may be identified by each participating physician with the addition of the modifier 66 to the basic procedure number used for reporting services.

Documentation establishing that a surgical team was medically necessary is required for certain services identified by Centers for Medicare & Medicaid Services (CMS). All claims for team surgeons must contain sufficient information

i.e., operative reports, to allow pricing “by report”.

Instructions

This modifier states a single, highly complex surgery or procedure that requires several physicians from the same or different specialties.

Correct Use

    Includes other highly skilled and specially trained personnel
    Includes different types of complex equipment
    Usually confined to organ transplant teams
    Reimbursed "by report"
    Medicare Physician Fee Schedule (MPFS) Indicator List
        "T" column indicator 1 or 2
        Claim subject to Medical Review and documentation will be requested
    Every surgeon MUST append modifier 66 to the CPT code                      

Incorrect Use

    Not appropriate for two or less surgeons


Claim Coding Example

Treatment Description


CPT/Modifier

Renal allotransplantation, implantation of graft; with recipient nephrectomy


50360 66


Team Surgery – Modifier 66

*Highly complex procedure requiring skills of different specialties

*Single procedure requiring more than two surgeons of different specialties

*Documentation required



DEFINITIONS 

Assistant Surgeon: A physician or other health care professional who is assisting the physician performing a surgical procedure.


Co-Surgeons: Several physicians (usually with different specialties) working together as primary surgeons performing distinct part(s) of a procedure. Claims submitted by co-surgeons are identified with modifier 62.

Team Surgeons: Three or more surgeons (with different or same specialties) working together during an operative session in the management of a specific surgical procedure. Claims submitted by Team Surgeons are identified with modifier 66.



QUESTIONS AND ANSWERS

1 Q: Why does Oxford not allow reimbursement for non-physicians performing Co-Surgeon services?

A: CMS claims processing manual guidelines for co-surgery refers to surgical procedures involving two different surgeons, usually of different specialties.


REIMBURSEMENT GUIDELINES

Team Surgeon Services

Modifier 66 identifies Team Surgeons involved in the care of a patient during surgery. Each Team Surgeon should submit the same CPT code with modifier 66.

Each Team Surgeon is required to submit written medical documentation describing the specific surgeon's involvement in the total procedure. For services included on the Team Surgeon Eligible List, Oxford will review each submission with its appropriate medical documentation and will make reimbursement decisions on a case-by-case basis.


Category        Indicator        Indicator Description

0  Team surgeons not permitted for this procedure

1 Team surgeons could be paid; supporting documentation required to establish medical necessity of a team, pay by report.

2 Team surgeons permitted, pay by report

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