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Thread: medicare denial for procedure...help??!

  1. #1
    Join Date
    Apr 2007
    Baton Rouge

    Default medicare denial for procedure...help??!

    AAPC: Back to School
    I have a patient who is currently at a specialty hospital (wound care/cardiac rehab, etc) and was seen by the surgeon at the local medical center for debridement of left iliac fossa wound. The next day the patient was transported to the physician's office by EMS b/c he "bled during the night". Turns out there was a small vessel just under the skin pumping away. this was sutured and the bleeding stopped. Pt was sent back to the specialty hospital. Billed 12004 and Medicare denied stating "invalid or missing modifier". I'm thinking that b/c the patient is in-patient at the specialty hospital and came to the physician office for treatment that maybe this is the issue....but I can't for the life of me come up with an applicable modifier. 78 won't work b/c the primary procedure done the day before has zero global days. Any suggestions??

  2. #2
    Join Date
    Apr 2007
    Lubbock, TX


    54 modifier, maybe?

  3. #3


    I think you should use a 58 modifier. I was told by our local Medicare carrier that anytime a debridement was done and patient had to have additional procedures performed that you would use a 58 modifier. If this works please let me know. I hope this helps some.

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