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Thread: modifier 66 vs 62

  1. #1
    Join Date
    Apr 2007
    Springfield, Missouri

    Exclamation modifier 66 vs 62

    AAPC: Back to School
    What is documentation requirements to bill for a 66 modifier vs a 62 ?

    When I bill for a 62 modifier I always look at the time in and time out for the surgeon's, based upon the defintion of 62 modifier.

    I have 2 surgeon's who were in the operating room at separate times with a neuro-surgeon. They exposed L1-L3 for repair of a burst fracture, one opened exposing while the other one assisted. Then the same two surgeon's closed.

    I need to find some further guidelines to explaining the 66 modfiier. Can someone please help!

    Thank you,

  2. #2
    Join Date
    Apr 2007
    Milwaukee WI

    Default How many op reports?

    How many op reports do you have?

    Sounds to me that you have a -62 and -80 (or -82 if you are in a teaching hospital and there ws no qualified resident).

    To be sure I'd need to see all the operative notes (and also know what specialties were involved).

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. #3


    If surgeons of different specialties are each performing a different procedure (with specific CPT codes) multiple surgery rules do not apply. If one of the surgeons performs multiple procedures, the multiple surgery rules apply to that physician's services.

    As per Medicare manual:
    The guidelines are noted as follows:

    Assistant at Surgery:

    " Some surgical procedures require a primary surgeon and an assistant surgeon. CMS has identified those surgical procedures for which an assistant surgeon may be reimbursed. Payment will not be made for the services of assistants at surgery furnished in a teaching hospital which has a training program related to the medical specialty required for the surgical procedure and has a qualified resident available to perform the service.

    Payment for an assistant surgeon is limited to 16% of the fee schedule amount for the surgical procedure. The Limiting Charge is 115% of the assistant surgeon's fee schedule amount.

    f.1 Reporting Guidelines

    Services for an assistant-at-surgery must be reported with one of the following modifiers as appropriate to the situation.

    Modifier 80 - This modifier is reported when the services are performed in a non-teaching setting or in a teaching setting when a resident was available but the surgeon opted not to use the resident. In the latter case the service is generally not covered by Medicare unless the following circumstances exist and are reported on the claim form:
    the primary surgeon has an across-the-board policy of never involving residents in the preoperative, operative, or post operative care of his/her patients.
    exceptional medical circumstances existed, e.g. emergency, life-threatening situations such as multiple traumatic injuries requiring immediate treatment.
    1.Modifier 81 - Minimum Assistant Surgeon: Minimum surgical assistant services are identified by adding modifier 81 to the usual procedure number.

    Modifier 82 - This modifier is reported when there is no qualified resident surgeon available or when the services are performed in a teaching hospital that does not have an approved training program related to the medical specialty required for the surgical procedure.

    g. Co-Surgery

    Under some circumstances, the individual skills of two surgeons are required to perform surgery on the same patient during the same operative session. This may be required because of the complex nature of the procedure(s) and/or the patient's condition. In these cases, the additional physician is not acting as an assistant-at-surgery.

    Co-surgery refers to a single surgical procedure which requires the skill of two surgeons (usually with different skills) of the same or different specialties performing parts of the same procedure simultaneously, e.g., heart transplant or bilateral knee replacements. It is not always co-surgery when two doctors perform surgery on the same patient during the same operative session. Co-surgery has been performed if the procedure(s) performed is part of and would be billed under the same surgical code, (e.g., the excision of a pituitary tumor (CPT code 61548) by an otolaryngologist and a neurosurgeon). In this case, each physician reports code 61548 with the 62 modifier (two surgeons). Payment for each surgeon is 62.5% of the Medicare Fee Schedule amount.
    1.Co-surgery has not been performed when each physician performed a separate surgical procedure which is reported under a different surgical procedure code, e.g., a hammertoe operation (CPT code 28285) performed by a podiatrist and a palma fasciotomy (CPT code 26040) performed by a hand surgeon. When two unrelated procedures are performed, each physician should bill for and be paid the full global fee for the procedure he/she performed.

    g.1 Eligible Co-surgery Procedure Codes

    There are 2 categories of surgical procedures for which co-surgery may be covered. Codes not listed as Category I or Category II are not eligible for reimbursement for co-surgery.

    Category I procedure codes can be paid for co-surgery when an operative report supporting the need for co-surgeons (of the same or different specialties) is submitted with the claim. Category II procedure codes do not require documentation of the medical necessity for co-surgery unless the co-surgery is performed by surgeons of the same specialty. If co-surgeons are of the same specialty, operative reports must be submitted.

    When performing co-surgery, it is important to communicate with the other surgeon's office to be certain that the claims are submitted properly.

    The Medicare Physician Fee Schedule Database at www.cms.gov/PhysicianFeeSched provides procedure code classifications/categories for all global surgery issues.

    h. Team Surgery

    Team surgery also refers to a single procedure; however, it requires the skills of more than two surgeons of different specialties, working together to carry out various portions of a complicated surgical procedure. For example, a kidney transplant could involve the services of a general surgeon, a urologist and/or a vascular surgeon to remove the diseased kidney, to implant the donated kidney and to transplant the ureters.
    1.CMS has identified those services for which team surgeons may be paid. Payment for codes defined as eligible for team surgery will be reimbursed on an individual consideration basis. The Limiting Charge is 115% of the fee schedule distributive share for each of the team physicians.

    h.1 Reporting Guidelines

    Each surgeon should bill for the procedure using the modifier 66 (Team Surgery) following the procedure code. Sufficient documentation establishing the medical necessity of a team of surgeons must accompany each claim, e.g., operative notes. "

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