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Medicare Misadventure Case Billing

  1. Default Medicare Misadventure Case Billing
    Medical Coding Books
    Pt. was undergoing hemorrhoidectomy using PPH stapler, when the stapler malfunctioned and her rectum was accidently stapled shut. Apparently a resection/repair was not a possibility in this case, and the pt. was sent emergently to a tertiary hospital where more advanced care was administered.
    I have come up with the diagnosis codes: 455.0, 455.3, 997.99 and E876.8. CPT code 46947.
    My question is, should I use a modifier 52? 53? Or should I even bill Medicare at all?
    Could anyone direct me to Medicare's policy/guidelines with regards to this scenario?

  2. #2
    Charlotte, NC
    I'm curious if you were able to find anything on this?

    I would've thought a 53 modifier would have sufficed.

  3. #3
    I agree, modifer 53 should be used.

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