Wiki EA, EB, EC Modifiers

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aglen

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The new modifiers EA, EB & EC go into effect April 7. I am still trying to understand when and how to use these modifiers. Does anyone know of where I can get information on this? My understanding is that we use these modifiers only when we code J0881 and J0885, and ESRD is not the diagnosis for the patient. Then we have to use EA for anemia, chemo-induced; EB anemia, radio-induced; or EC anemia, non chemo/radio. If this is correct, then that is an easy way to explain it to our other coders.

Thanks so much!
 
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Coding EPO's is confusing no matter what. Its always a challenge since policies are constantly changing and you need to consider NCD's and LCD's. Our medicare carrier is WPS and their website has been great with helping out with this.

We primarily use aranesp J0881, but we do give procrit occasionally.

If a patient has a diagnosis of renal failure we use the EC modifier. If the patient is on chemo (last tx within 3 months) we use EA.

Double check with your local carrier and make sure you are meeting all other requirements for giving EPO's, it can be tricky.
 
I post charges for our CKD clinic. We give Procrit to pre-dialysis patients at this units. One site that I have found helpful is http://www.procritline.com/ This website has links for each state. The modifiers are EA: ESA, anemia, chemo-induced; EB: ESA, anemia, radio-induced; and EC: ESA, anemia, non-chemo/radio. I'm sure that you've seen that you now have to report the HgB or HCT as well. You continue to use the EJ modifier to report subsequent administrations of ESAs. Non-ESRD claims that do not report one of the three modifiers will be returned. And any claim not reporting the most recent HCT or HgB will also be returned. We've been doing this since January. We have had some problems with Humana. We've had several of those claims returned. I think that they also want the creatinine to be reported. We're sorting that out right now.

I hope this helps!
 
I post charges for CKD patients on Procrit (J0885) for our Nephrology office. We use the EC modifier on all medicare & medicare managed care patients. And yes, don't forget to put the hgb & hct! Also, are you reporting the PQRI measures when these patients are seen by the doctor & also have a Procrit injection??
 
It's a nightmare, we also use WPS as our local carrier so their website is pretty informative. One thing I still don't understand is why do we have to use 285.9 which is an unspecified code when all along we've been using 285.21 with CKD or 285.22 w/neoplasm related?????
 
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