Modifier JW With Drug Codes

June 27th, 2017 - Find-A-Code
Categories:   Coding   Modifiers   Drugs|Pharmaceuticals|FDA  
0 Votes - Sign in to vote or comment.

Modifier JW

In the past, some Medicare Administrative Contractors have required providers to report wasted drugs with modifier JW (Drug amount discarded/not administered to any patient). Use of the modifier was at the contractor’s discretion, and some contractors told providers not to report it. But effective January 1, 2017, all providers (hospitals, freestanding centers and physician offices) will be required to use modifier JW, and they will continue to be required to document the amount of discarded drug in the individual patient’s medical record. Medicare’s discarded drug policy is located in Chapter 17 of the Medicare Claims Processing Manual. Briefly, it states that when a provider administers part of a single-use vial or other single-use package to a Medicare patient, and the rest of the container must be discarded, Medicare will pay both for the amount that was administered and the amount that was discarded. Note that this policy applies only to single-use containers or single-use vials. If part of a multi-use container is discarded, the provider may bill only for the amount that was actually administered to the patient.

The provider must report the drug on the claim as two separate charges: one claim line for the amount administered (with no modifier), and one claim line for the discarded drug amount, with modifier JW. For example, code J9035 represents Avastin (bevacizumab): 1 unit per 10 mg. If a patient is given 980 mg from two 400 mg and two 100 mg single use vials (total 1000 mg), and the remainder of the last vial is discarded (20 mg), the provider should report the following:

J9035 x 98 units (administered 980 mg)

J9035-JW x 2 units (wasted 20 mg)

Remember to price each line appropriately as well; the charge for the drug administered + the charge for the drug amount wasted should equal the total dollar amount of drug billed. Providers will be paid for both claim lines; CMS simply wants to track the amount Medicare pays for wasted drugs. CMS states that modifier JW should not be used “if the billing unit is equal to or greater than the total actual dose and the amount discarded.” For example, 2 mcg of sincalide is administered to a patient from a 5 mcg single use vial, and the remainder is discarded. Sincalide is reported with code J2805 (Injection, sincalide, 5 micrograms). Since 1 unit of the code is equal to the total amount administered plus the amount discarded, the provider will report 1 unit of code J2805 and modifier JW will not be applied.

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

2023 ICD-10-CM Code Changes
October 6th, 2022 - Christine Woolstenhulme, CPC, CMRS, QCC, QMCS
In 2022 there were 159 new codes; the 2023 ICD-10-CM code update includes 1,176 new, 28 revised, and 287 deleted codes, a substantial change from last year. The 2023 ICD-10-CM codes are to be used for discharges from October 1, 2022 through September 30, 2023, and for patient encounters from ...
Emergency Department - APC Reimbursement Method
September 15th, 2022 - Christine Woolstenhulme, CPC, CMRS, QCC, QMCS
CMS pays emergency department visits through a payment method using Ambulatory Payment Classifications (APCs). Most payers also use the APC reimbursement system; however, there may be some differences in payer policies (always review your specific payer policy). APCs are the primary type of payment made under the OPPS, comprising groupings ...
Why Medical Coding and Billing Software Desperately Needs AI
September 7th, 2022 - Find-A-Code
It has been said that the healthcare industry is notoriously slow in terms of technology adoption. One need only look at how convoluted medical coding and billing are to know that it needs a technology injection. Specifically, medical coding and billing software desperately needs artificial intelligence (AI).
CMS says Less Paperwork for DME Suppliers after Jan 2023!
August 18th, 2022 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
Attention providers, suppliers, billers, and vendors who bill Durable Medical Equipment (DME) to Medicare!  Currently, a supplier receives a signed Certificate of Medical Necessity (CMN) from the treating physician or creates and signs a DME Information Form (DIFs); these are required to be sent with the claim. However, this is about ...
Things to Consider Before Upgrading Medical Billing Software
August 11th, 2022 - Find-A-Code
Your practice has utilized the same medical billing software for years. The medical billing staff says it is time for a change. You don't necessarily disagree, but you also don't know where to begin your search for new software. There are so many vendors offering so many products that making sense of it all can be challenging.
Calendar Year 2023 Medicare Advantage and Part C & D Payment Policies
August 9th, 2022 - Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Each year CMS publishes an Advance Notice of the upcoming years Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies and asks for comments related to it. Each of the comments are carefully reviewed and responded to and often are impactful to changes seen between the Advance Notice and final publication referred to as the Rate Announcement. With health equity as a primary focus for 2023, CMS announced some policy changes that may impact your organization.
How CMS Determines Which Telehealth Services are Risk Adjustable
August 9th, 2022 - Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Medicare Advantage Organizations (MAOs) have gone back and forth on whether or not to use data collected from telehealth, virtual Care, and telephone (audio-only) encounters with Medicare beneficiaries for risk adjustment reporting, but the following published documents from CMS cleared that up once and for all by providing an answer to a question specifically related to this question.



Home About Contact Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2022 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association