Wiki Modifier EE

[jennifer@ivinson]

*(I posted this a year ago and didn't receive any guidance, I thought I would try once more). I am hoping for some direction on how to get the description for HCPCS Level II Modifier EE reviewed. CMS states "*EE: Hematocrit GREATER than 39.0% or hemoglobin greater than 13.0g/dL for less than 3 consecutive billing cycles immediately prior to and including the current billing cycle" but HCPCS Level II Modifiers states "Hematocrit level has NOT EXCEEDED 39%....................". Any help on the review or ideas on which to follow is appreciated!

 

[iowagirl77]

I think the HCPCS description is very poorly phrased, but I believe they are basically saying the same thing for modifier EE:
HCPCS: Hematocrit level has not exceeded 39% (or hemoglobin level has not exceeded 13.0 g/dl) for 3 or more consecutive billing cycles immediately prior to and including the current cycle.
CMS: The hematocrit level has exceeded 39.0%(or hemoglobin level has exceeded 13.0g/dL) less than 3 consecutive billing cycles immediately prior to and including the current billing cycle.

Per CMS guidance https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1307CP.pdf 'Claims must include either the ED or EE modifier if hematocrit exceeds 39.0% or hemoglobin exceeds 13.0g/dL.'

So modifier EE should be used if the hematocrit level has exceeded 39% (or hemoglobin level has exceeded 13.0g/dL) for 1 or 2 consecutive billing cycles (immediately prior to including the current cycle). If it has exceeded this level for 3 or more consecutive cycles, use mod ED.