Medicare and modifier -78

meo59101

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I have a patient who had drainage of an ear abscess 69020 on 1/7/2011. Seven days later same patient had tympanomastoidectomy, 69641. Medicare will not pay on a -78 modifier for the second procedure, stating that there is a more appropriate modifier. Would anyone happen to know what modifier for the 69641 would be acceptable to Medicare?
Thanks
 
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