Modifier Coding Alert

Published on Fri Oct 17, 2014 PDF

Question: Two doctors from our practice worked with other doctors as a team for a liver transplant. The team consisted of a general surgeon specializing in organ transplant, a gastrointestinal surgeon, a vascular surgeon, neurosurgeon, and a plastic surgeon to perform all the various portions of these procedures. Can I use modifier 66 on the procedures performed by both our doctors?

West Virginia Subscriber

Answer: You will use modifier 66 (Surgical team) on the liver transplant procedure (47135-47136, Liver allotransplantation ...) for each provider to tell the payer that the providers were part of a surgical team. The insurance pays each surgical team provider a specific amount instead of paying one provider the full amount for the procedure.

“Depending on what each provider does, will depend on whether the modifier is needed,” says Suzan Berman (Hauptman), MPM, CPC, CEMC, CEDC, director of coding operations-HIM at Allegheny Health Network in Pittsburgh, Pa. “If one of the surgeons performs a procedure so that another surgeon can perform a totally different procedure, then the modifier wouldn’t be needed by either surgeon. Each surgeon would bill for the procedure each one performed.”

Tip: Your provider’s documentation has to include a specific description of the procedure performed and include the fact that the provider was part of a surgical team in order for you to report with modifier 66 and you should consult with your payer