Cardiology Coding Alert

Use the extra time to check your documentation and coding skills are ready.

In the last issue of Cardiology Coding Alert, "Prep for New National JW Rule," discussed Medicare's new rule requiring use of modifier JW. At the time the article went to print, July 1, 2016, was the effective date for the change,

News flash: Medicare announced that the effective date for the change will be Jan. 1, 2017, not July 1, 2016. The change gives you and MACs more time to implement the change.

Refresher: National Medicare currently lets each MAC set its own rules about whether providers have to append modifier JW (Drug amount discarded/not administered to any patient) to a code to report drug waste from a single-use vial or package for Part B.

Starting in January, CMS will require everyone to use modifier JW as well as note the discarded drug in the patient's chart. You'll report the amount administered on one line with the amount discarded on a second line. Include JW on the line for the amount discarded.

If you've been confused about when to use modifier JW, this standardization of the rule should be welcome news, says Marvel Hammer, RN, CPC, CCS-P, ACS-PM, CPCO, owner of MJH Consulting in Denver. And remember that using JW doesn't jeopardize your reimbursement. Medicare will pay for the complete single-use vial or package, including the amount wasted.

Caution: Be sure you don't overuse JW. If the appropriate billing unit for the drug represents an amount equal to or greater than the total amount administered and wasted, you should not use JW. An example will help make this rule clear.

Example: Suppose for code Jxxxx, 1 billing unit represents 10 mg. The single-use vial the nurse uses is labeled as having 10 mg. She administers 7 mg and discards 3 mg. Even though the nurse wastes 3 mg, you should report a single line item with a single unit and no modifier JW. If you instead reported 1 unit for the amount administered and 1 unit for the amount wasted, you would be reporting double what your practice supplied, risking overpayment.

Resource: For more information, see www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9603.pdf.