Cardiology Coding Alert

Question: I heard there's finally a single rule about how to use modifier JW. What is it, and has it started yet?

Missouri Subscriber

Answer: You heard right. Mark your calendars for July 1, 2016. On this date, the new CMS change request (CR 9603) for modifier JW (Drug amount discarded/not administered to any patient) will go into effect. It relates to Part B drugs and biologicals (except Competitive Acquisition Program) and how you report them to MACs, CMS says in MLN Matters article MM9603.

Currently, national Medicare allows each MAC to determine whether providers have to append modifier JW to a code to reflect that some of the drug was wasted.

In an effort to standardize policies, CMS will soon require everyone to use modifier JW as well as note the discarded drug in the patient's chart.

2 line items: "This modifier, billed on a separate line, will provide payment for the amount of discarded drug or biological," says the updated version of the Medicare Claims Processing Manual, Chapter 17, Section 40.

"For example, a single use vial that is labeled to contain 100 units of a drug has 95 units administered to the patient and 5 units discarded. The 95 unit dose is billed on one line, while the discarded 5 units shall be billed on another line by using the JW modifier. Both line items would be processed for payment. Providers must record the discarded amounts of drugs and biologicals in the patient's medical record," the Manual goes on to say.

Resource: For more information on the JW change, visit www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9603.pdf. You can see the transmittal with the announcement at https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3530CP.pdf.