Modifier 66

When is modifier 66 used?

In the context of highly complex surgical procedures, the modifier 60 indicates that the procedure was performed by a surgical team rather than a single surgeon. This model of care allows for the pooling of expertise and resources to successfully address intricate or extensive medical conditions. The decision to utilize the surgical team concept is typically made by the participating physicians or qualified healthcare professionals involved in the patient’s care. To accurately reflect the collaborative nature of the procedure, modifier 66 should be appended to the basic procedure code when reporting services.

By incorporating modifier 66, healthcare providers communicate to payers that the procedure involved collaboration among multiple skilled individuals to ensure the best possible outcome for the patient.

In summary, the use of modifier 60 denotes the utilization of a surgical team for complex procedures, with modifier 66 added to the procedure code to signify collaboration among healthcare professionals.

Examples of modifier 66

Modifier 60 – Surgical team: This modifier is used when highly complex surgical procedures are performed by multiple surgeons working together as a team. Each surgeon involved in the procedure should report the same procedure code with modifier 60 appended. This indicates that the surgery was performed by a surgical team, rather than a single surgeon.

Scenario 1: A patient presents with a severely fractured femur requiring surgical repair. Due to the complexity of the fracture, an orthopedic surgeon and a trauma surgeon collaborate to perform the surgery. Both surgeons would report the procedure with modifier 60 to indicate the surgical team approach.

Scenario 2: A patient undergoes a complex spinal fusion procedure that involves multiple levels of the spine and intricate instrumentation placement. A neurosurgeon and an orthopedic surgeon team up to perform the surgery. Both surgeons would bill for the procedure with modifier 60 to signify the joint effort of the surgical team.

Scenario 3:

A patient requires a liver transplant, a highly complex procedure that involves coordination between a transplant surgeon, a hepatologist, and an anesthesiologist. The team of specialists works together to successfully perform the surgery, with each physician contributing their expertise to ensure a positive outcome. In this scenario, Modifier 66 would be appended to the procedure code to indicate the collaborative effort of the surgical team.

Scenario 4:

A patient sustains severe facial trauma in a car accident, necessitating reconstructive surgery involving a plastic surgeon, an oral surgeon, and a maxillofacial surgeon. The surgical team collaborates to repair the extensive injuries and restore the patient’s facial structure and function. Modifier 66 is applied to the procedure code to highlight the combined skill sets of the specialists involved in the intricate surgical procedure.