decisionhealth Newsletters, Answer Books - 2009 Issue 2 (February)
Modifier -66 / How to get paid for the team approach
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Article Overview
This article discusses team-based surgical billing in CPT and the circumstances under which claims involving multiple physicians may be reviewed by payers. It is aimed at coders, billing staff, and practices that submit claims for complex procedures where more than one surgeon is involved. The article covers the general role of modifier -66, payer review concepts, and the difference between duplicate and non-duplicate procedure reporting in a team setting.
Why This Topic Matters
Understanding this topic helps billing teams recognize when a team-based surgical claim may draw payer scrutiny and how such claims are generally organized for review. It is relevant to avoiding avoidable claim delays in complex multi-physician procedures.
What You Will Learn
- How team-based surgical services are discussed in CPT billing contexts
- Why claims with multiple physicians may receive manual review
- How payer processing can differ when physicians report the same or different procedure codes
- What types of procedures are generally associated with team-based billing discussions
Who Should Read This
- Medical coders
- Billing specialists
- Physician practices
- Hospital reimbursement staff
Codes Discussed
Modifiers Discussed
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