Modifier Coding Alert

Question: A healthcare professional administered 100 mg of herceptin to a patient from a 440 mg multi-use vial. How many units should I report? Do I need a modifier?

Oregon Subscriber

Answer: For 100 mg, you should report 10 units (as the quantity billed) of J9355 (Injection, trastuzumab, 10 mg). Each unit of J9355 represents 10 mg. If you divide the 100 mg administered by the 10 mg in the definition, the solution is 10 units. 

Since the vial was a multi-use vial, a healthcare professional will use the 340 mg for another patient and you don’t need modifier JW. But your payer may require modifier JW (Drug amount discarded/not administered to any patient) because there was a drug surplus. Using JW means it was a single-use vial and the surplus is discarded by a healthcare professional. 

Key: You should not report 44 units to represent the complete 440 mg multi-use vial. 

Note: To properly report any drug or biological, you need to distinguish multi-use vials (for which waste is not reportable to Medicare) from single-use vials (for which waste is reportable to Medicare).