7/25/2019 Adjust to Modifier JW Change by January (Not July)
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The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713,
Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
[email protected]
Adjust to Modifier JW Change by January (Not July)
By Susan Dooley
For years, Medicare has had a rule that lets local MACs decide
whether their providers have to
usemodifier JW (Drug amount discarded/not administered to any
patient). All that is about to change.
Effective Jan. 1, 2017, Medicare will require modifier JW use by
all providers for discarded Part B drugs
and biologicals. The implementation date is Jan. 3. (Medicare
originally stated July 1, 2016, was the
effective date, but recently announced a revision changing the
date to Jan. 1.)
Focus on When JW Applies to Avoid Misuse
If your MAC already requires you to use modifier JW, then you
may not have much to change. But if you
havent been using the modifier, be sure you dont miss these
rules.
mailto:[email protected]:[email protected]
7/25/2019 Adjust to Modifier JW Change by January (Not July)
2/3
The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713,
Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
[email protected]
Use JW for claims with unused drugs or biologicals that meet
these conditions:
From single-use vials or single-use packages
Appropriately discarded
Not provided under the Competitive Acquisition Program (CAP) for
Part B drugs and biologicals.
Important: CMS requires documentation of the discarded drug or
biological in the patients record, so be
sure that information is present before you submit the claim for
the unused portion.
Increase Your Understanding With 2 Examples
To be sure youre using modifier JW appropriately, review these
examples based on the ones CMS
provides in the updated version of the Medicare Claims
Processing Manual, Chapter 17, Section 40.
When using JW, youll report separate line items for the amount
administered and the amountdiscarded, as shown in Example 1.
(Theres an exception to watch for, too, shown in Example 2.)
Example 1: A single-use vial label shows it has 100 units of a
drug. Lets say the codeis Jxxxx, and you
report 1 billing unit per drug unit based on the code
descriptor. The nurse documents administering 95
units to the patient and discarding 5 units. You should
report:
Jxxxx, 95 units
Jxxxx-JW, 5 units.
Medicare will process both lines for payment, so you can rest
easy on that point.
Example 2: A single-use vial label shows it has 10 mg. Lets say
the code is Qxxxx, and you report 1 billing
unit per 10 mg based on the code descriptor. The nurse documents
administering 7 mg to the patient
and discarding 3 mg. Because 1 billing unit is equal to 10 mg,
you should report only 1 billing unit:
Qxxxx, 1 unit.
Rationale:If you reported 1 unit for the 7 mg administered on
one line item and 1 unit with JW for the 3
mg wasted on another line item, youd be billing 2 units and
getting paid for 20 mg instead of 10 mg.Thats overreporting and
would lead to overpayment.
Bottom line:Put your math skills to work. If the billing unit is
equal to or greater than the total of the
amount administered plus the amount wasted, you should not use
modifier JW.
mailto:[email protected]:[email protected]
7/25/2019 Adjust to Modifier JW Change by January (Not July)
3/3
The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713,
Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
[email protected]
How About You?
We all know how important proper modifier use is to a clean
claim. Are you worried about having to
apply this new universal rule for modifier JW?
Stay Up-to-Date With Part B Coders News, Tools, and Code
Sets
To be sure you dont miss important updates like this modifier JW
change, take advantage of the weekly
newsletters from Part B Coder. Youll stay on top of the latest
news, plus have access to SuperCoders
powerful combination of code search and compliance tools!
Contact us for a free copy today!
Contact Us:
Name: Sam Nair
Title: Associate Director
Email:[email protected]
Direct: 704 303 8150
The Coding Institute LLC, 2222 Sedwick Road, Durham, NC
27713
mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]
