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62, 66 or no modifier?

  1. #1
    Default 62, 66 or no modifier?
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    I keep confusing myself on this one. I have two MDs, both General Surgeons. Since they're the same specialty I don't believe I need modifier 62.
    Laparoscopic Heller myotomy (Dr. A)
    Partial fundoplication (Dr. A)
    Intraoperative EGD (Dr. B)
    Dr. A performs the myotomy, steps back and Dr. B does the EGD, Dr B leaves, and Dr. A does the fundoplication. Both have separate op-notes. I'm thinking I can submit only the surgical charges that each one did, with no modifier. Am I right? I don't get the guidelines for 66. Why would I report all CPT codes for both physicians, if both physicians didn't do all the procedures? Thank you for any help you can give.

  2. Default
    For modifier -66 the guideline states, "Under some circumstances, highly complex procedures(requiring the concomitant services of several physicians, often of different specialties, plus other highly skilled trained personnel, variouse types of complex equipment) are carried out under the "surgical team" concept.

    Since the guideline says several physicians are required to make up a surgical team, since there are only two physicians participating, I would not use modifier -66.

  3. #3
    So does this mean that you would bill out only each portion that each surgeon did under their own names with no modifier?
    Sorry, I just wanted to make sure I was clear on your answer.

  4. Default
    Since the surgeons are of same specialties, you cannot use modifier -62 and since the guideline for modifier -66 requires several physicians and there were only 2, I would not use that modifier.

    Depending on the op reports, there has to be a primary procedure(the reason for the surgery) and the other procedures I would bill with modifier -59 if the procedures are distinct and are medically necessary and/or modifier -51 for multiple procedures for multiple procedures that are performed by the same physician in the same session.

    I would bill separately for whatever procedure each physician did. But cannot bill the same procedures for both doctors, that will be like the insurance company paying twice for one procedure. So, carefully look at both op reports to make sure they are not claiming the same procedures.

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