Modifier 80 and 66

Let us see the usage of Modifier 80 and Modifier 66 in this below article:

Modifier 80 – Assistant Surgeon:

Append modifier 80 for assistant surgeon services to the usual procedure codes.

Usage of Modifier 80 along with examples

Whenever both surgeon and assistant surgeon involves in treating the patient, we need to add modifier 80, while reporting the claims for assistance surgeon.

Example:

CABG:

Let us assume providers (Primary surgeon and Assistant surgeon) involved to perform venous graft procurement.

In this above example primary surgeon is reported with procedure code 33510 to 33516 for reimbursement.

But when it comes for reporting the claim for surgical assistant, then we need to add modifier 80 to procedure code 33510 to 33516.

Example: 33510 with modifier 80

It means when assistant surgeon involves or performs venous graft, we need to append modifier 80 to reimburse the payment of assistant surgeon from the insurance company by indicating assistant surgeon also involved while performing the venous graft procurement service.

If the claim is reported to the insurance company for assistant surgeon without appending modifier 80, then the insurance company will deny the claim as duplicate. Because the same service will be reported by primary surgeon to insurance company in order to reimburse the payment for his service.

Same like that when surgical assistant performs arterial and or venous graft procurement, add modifier 80 to 33517-33523, 33533-33536 as appropriate to reimburse the payment of assistant surgeon when performed.

For Example: 33517 with modifier 80

Modifier 66 – Surgical Team:

Modifier 66 is appended with appropriate procedure codes when surgical team involved in performing the highly complex services.

Some of the major surgeries or highly complex procedures are performed with surgical team, then those procedure codes are reported with modifier 66 to indicate that the surgical team involved in performing the services.

Usage of modifier 66 with examples:

  1. Surgical team is involved to perform renal transplantation procedure.

To perform the renal transplantation service, usually requires two or more surgeons to perform the service. If two surgeons involved and work together as primary surgeons, then we report the procedure code by appending modifier 62.

If it is more than two surgeons involved we call it as surgical team, then we report the appropriate procedure codes by appending modifier 66 to indicate surgical team involved in performing this services.

Example:

Assume surgical team performed the renal autotransplatation, reimplantation of kidney.

We report the claim to insurance company as follows:

50380 with modifier 66

2) Assume two surgeon involved to perform the reposition of Bones as primary surgeon

In this example only two surgeons were involved as primary surgeon to perform the reposition of bones. So in this case, the claim should be reported with modifier 62 for reimbursement.

Suppose if claim reported with modifier 66, then claim will be denied by insurance as supporting document does not support or indicate surgical team involved in performing the service.

So we need to be careful while selecting the modifier to bill the claim when more than two surgeons are involved as primary surgeons.

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