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66 vs no modifier

  1. #1
    Greater Pittsburgh
    Cool 66 vs no modifier
    Medical Coding Books
    Patient had spine surgery with 2 neurosurgeons from the same practice, but not my practice. They did: re-exploratory laminectomy L3-S1; interbody fusion L4-L5 and L5-S1; removal posterior instrumentation; pedicule instrumentation L3-S1; posterlateral fusion L4-S1.

    My Dr. Orthopaedic did sacral fixation and dictated separately.

    Plastic surgeon did gluteal flap coverage and closure and dictated separately.

    For my Dr.Ortho-sacral I need a 66 or no modifier.

    Thank you in advance for your assistance.
    Last edited by jdemar; 07-31-2009 at 10:15 AM.
    jdemar, CPC, CMA

  2. #2
    Default Looks like you need modifier 62
    Modifier 66 is when more than 2 surgeons (i.e., a "team") are billing for the same code (modifier 62 is for 2 surgeons). Since it looks like each of these providers performed a portion of the procedures listed, you will need to agree on codes and reimbursement split with the other provider, bill the same codes with modifier 62 appended to each code billed. Per 2008 Coder's Desk Reference (copyright Ingenix 2007), for modifier 62 it states, "...List multiple related procedures as though one physician performed all procedures and add modifier 62. The surgeons should agree on charges, procedure codes, and reimbursement percentage splits pror to submission. Because of many variables, it is imperative you coordinate the physicians' billing, and submit complete and detailed documentation."


  3. #3
    Greater Pittsburgh
    62 it is! Thank you for your help. I had only ever used 62 when my Dr. Ortho and Dr. Neuro did surgery together, and I guess the definition (two surgeons) threw me! Thanks again
    Last edited by jdemar; 08-05-2009 at 05:31 AM.
    jdemar, CPC, CMA

  4. #4
    Milwaukee WI
    Default Modifier 66
    I think in your scenario you ARE looking at modifier 66 ... you have 4 surgeons involved (2 neuro, 1 ortho, 1 plastics)

    All PB's comments re coordinating coding, billing, splits, etc and providing full documentation still apply.

    F Tessa Bartels, CPC, CEMC

  5. #5
    Greater Pittsburgh
    That's what I thought (66), because there were more than 2, ie(co surgeons 62).

    I understand and have always coordinated the CPT s and ICD-9-CM with other offices that were involved with co surgery.

    Thank you for your assistance. I am awaiting our reimbursement with the 66 modifier.
    Last edited by jdemar; 08-11-2009 at 01:49 PM.
    jdemar, CPC, CMA

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