Billing modifiers 62 , 66 , 73 & 74 - 2014

Medicare Part B modifiers - 62

Two surgeons: Under certain circumstances the skills of two surgeons (usually with different skills) may be required in the management of a specific surgical procedure. Under such circumstances the separate services may be identified by adding the modifier 62 to the procedure number used by each surgeon for reporting his services.

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.

If two surgeons, usually with different skills, are required to perform a single

surgical procedure, each surgeon bills for the procedure with modifier 62. Cosurgery also refers to single surgical procedures involving two surgeons performing the parts of the procedure simultaneously, e.g., heart transplant or bilateral knee replacements. Documentation of the medical necessity for two surgeons is required for certain services identified by Centers for Medicare & Medicaid Services (CMS).

Medicare Part B modifiers - 66

Surgical Team: Under some circumstances, highly complex procedures (requiring the concomitant services of several physicians, often of different specialties, plus other highly skilled, specially trained personnel and various types of complex equipment) are carried out under the “surgical team” concept. Such circumstances may be identified by each participating physician with the addition of the modifier 66 to the basic procedure number used for reporting services.

All claims for team surgeons must contain sufficient information i.e., operative reports, to allow pricing “by report”.

Medicare Part B modifiers - 73

Discontinued out-patient hospital/ambulatory surgical center (ASC) procedure prior to the administration of anesthesia: due to extenuating circumstances or those that threaten the well being of the patient, the physician may cancel a surgical or diagnostic procedure subsequent to the patient’s surgical preparation (including sedation when provided, and being taken to the room where the procedure is to be preformed), but prior to the administration of anesthesia (local, regional block(s) or general). Under these circumstances, the intended service that is prepared for but cancelled can be reported by its usual procedure number and the addition of the modifier 73.

Note: The elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported. For physician reporting of a discontinued procedure, see modifier 53.

Medicare Part B modifiers - 74

Discontinued out-patient hospital/ambulatory surgical center (ASC) procedure after administration of anesthesia: due to extenuating circumstances or those that threaten the well being of the patient, the physician may terminate a surgical or diagnostic procedure after the administration of anesthesia (local, regional block(s) or general) or after the procedure was started (incision made, intubation started, scope inserted, etc.). Under these circumstances, the procedure started but terminated can be reported by its usual procedure number and the addition of the modifier 74.

Note: The elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported. For physician reporting of a discontinued procedure, see modifier 53.