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Thread: Medicare Misadventure Case Billing

  1. #1

    Default Medicare Misadventure Case Billing

    AAPC: Back to School
    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
    Join Date
    Apr 2007
    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
    Join Date
    Apr 2007


    I agree, modifer 53 should be used.

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