garivo06 Posted Tue 23rd of April, 2013 20:55:18 PM
What are the guidelines to stage for CKD anemia for J0885 modifier EC
SuperCoder Answered Tue 23rd of April, 2013 21:02:55 PM
Modifier EC: When non-ESRD ESA treatment is for anemia not secondary to chemotherapy or radiation, modifier EC applies. Transmittal 1413 supplies a long list of diagnoses that will lead to an instant denial when on the same claim as J0881-EC or J0885-EC. For example, if you report a code from 280.x (Iron deficiency anemias) on your modifier EC claim, expect a denial.
Modifiers EA and EC are the two you're most likely to use, notes Ballard. You can find Transmittal 1413 online at www.cms.hhs.gov/transmittals/downloads/R1413CP.pdf. If you want to know which ICD-9 codes support medical necessity, you'll need to check your payer's local coverage determination (LCD). You'll often find instructions to report multiple diagnosis codes, such as a code for the anemia as well as a code for the cause of the anemia.