Wiki Modifier EE

[jennifer@ivinson]

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!

 

[Deborah Marsh]

Hi – I found this email at https://www.cms.gov/medicare/coding/medhcpcsgeninfo/hcpcs_coding_questions





I think the issue may be that other resources need to be updated, and also be sure to check the full descriptors.

If you look at the current full descriptor, it says, “has not exceeded … for 3 or more consecutive billing cycles.”

But there are still resources like the Medicare Claims Processing Manual that say, “has exceeded … [for] less than 3.” So that more than and less than are important.



HCPCS official site: https://www.cms.gov/medicare/coding/hcpcsreleasecodesets/hcpcs-quarterly-update

EE: 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



MCPM: https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c08.pdf

“The definition of modifier EE is ‘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.’”


Hope that's helpful!