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)

A 2020 Radiology Coding Change You Need To Know
February 10th, 2020 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
The radiology section of the 2020 CPT© has 1 new, 18 revised, and 14 deleted codes. Interestingly, six of the 14 deleted codes were specific to reporting single-photon computerized tomographic (SPECT) imaging services of the brain, heart, liver, bladder, and others. If your organization reports radiology services, it is...
Documenting telephone calls at your dental practice is just as important as documenting patient visits.
February 4th, 2020 - Christine Taxin
Documenting telephone calls at your dental practice is just as important as documenting patient visits. Similar to other documentation, the common rule when it comes to call documentation is that if it is not documented, it did not happen. Therefore, every clinically relevant telephone call should be documented. Clinically relevant calls ...
CPT 10-Year Historical Content - Now Available!
January 22nd, 2020 - Find-A-Code
Did You Know? We now offer Historical CPT Content in 2-year, 5-year, or 10-year options! Utilize access to specific CPT historical data for previous years using rules effective at that specific time. If you’ve added UCR fees to your account, you can use Historical CPT Content to view UCR fees from ...
Inadequate Exclusion Screenings Could Put Your Practice at Risk
January 21st, 2020 - Wyn Staheli, Director of Research
Exclusion screenings require far more than just checking a name on a federal database at the time you are hiring someone. Far too many providers don’t realize that in order to meet compliance requirements, there is MUCH more involved. There are actually over 40 exclusion screening databases/lists that need to be checked.
Q/A: How do we Bill Massage Services?
January 21st, 2020 - Wyn Staheli, Director of Research
Question: We are adding a massage therapist soon and have some questions about billing their services.
Billing for Telemedicine in Chiropractic
January 14th, 2020 - Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP
Many large private payers recognize the potential cost savings and improved health outcomes that telemedicine can help achieve, therefore they are often willing to cover it. While there are several considerations, there could be certain circumstances where telemedicine might apply to chiropractic care.
Non-Surgical Periodontal Treatment
January 14th, 2020 - Christine Taxin
AAP treatment guidelines stress that periodontal health should be achieved in the least invasive and most cost-effective manner. This is often accomplished through non-surgical periodontal treatment.Non-surgical periodontal treatment does have its limitations. When it does not achieve periodontal health, surgery may be indicated to restore periodontal health.SCALING AND ROOT PLANINGScaling ...



About Codapedia by innoviHealth® Contact Us Terms of Use Privacy Policy Advertise with Us

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

Copyright © 2000-2020 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association