Modifier 66 | Surgical Team Explained

Modifier 66 indicates that a provider was part of a surgical team performing a highly complex or challenging procedure. In this article, we will explain modifier 66, including its definition, when to use it, documentation requirements, billing guidelines, common mistakes to avoid, related modifiers, and additional tips for medical coders.

1. What is modifier 66?

Modifier 66 describes a situation where a surgical team, consisting of three or more providers of different specialties and other highly skilled clinicians, performs work on the same procedure, often using complex surgical equipment.

Each provider on the team should document the procedure in the patient’s record. Each provider reports the same procedure code to the payer, appending modifier 66 to the code.

Modifier 66 tells the payer that the provider was part of a surgical team. The insurance pays each surgical team a specific amount instead of paying one provider the full amount for the procedure.

2. When to use modifier 66?

Modifier 66 is appropriate when the provider who performed the procedure was part of a surgical team performing a highly complex or difficult procedure.

Examples of procedures that require team surgery include multi-stage transplant surgery and some types of cardiac surgery, where each provider has a set of special skills that enable him to perform a unique part of the procedure.

Providers of different specialties may also work together as a surgical team because the patient has several conditions that require specialized and diverse skills.

3. Description

The official description of modifier 66 is “surgical team.”

4. Examples

Examples of procedures that require modifier 66 include:

• Multi-stage transplant surgery
• Cardiac surgery
• Neurosurgery
• Orthopedic surgery
• Plastic surgery

5. Documentation

When using modifier 66, the provider’s documentation should include a specific description of the procedure performed and indicate that the provider was part of a surgical team.

Each provider on the team should document the procedure in the patient’s record. The documentation should also include the names and specialties of all providers involved in the surgical team.

6. Billing

When billing for a procedure that involves a surgical team, each provider on the team should report the same procedure code to the payer, appending modifier 66 to the code.

The insurance pays each surgical team provides a specific amount instead of paying one provider the full amount for the procedure.

7. Common mistakes

Common mistakes that medical coders make when using modifier 66 include:

• Using modifier 66 for procedures that do not involve a surgical team
• Not including the names and specialties of all providers involved in the surgical team in the documentation
• Not appending modifier 66 to the procedure code

To avoid these mistakes, medical coders should ensure that they clearly understand the definition and appropriate use of modifier 66.

8. Other modifiers related to modifier 66

Other modifiers related to modifier 66 include:

• Modifier 62 – Two surgeons
• Modifier 80 – Assistant surgeon
• Modifier 82 – Assistant surgeon (when qualified resident surgeon not available)

Medical coders should be familiar with these modifiers and their appropriate use in medical billing and coding.

9. Tips

Additional tips for medical coders using modifier 66 include:

• Ensure that the provider’s documentation includes a specific description of the procedure performed and indicates that the provider was part of a surgical team
• Verify that all providers involved in the surgical team are included in the documentation
• Double-check that modifier 66 is appended to the procedure code