Oncology & Hematology Coding Alert

Question: Is the point of new MLN Matters article MM6711 that modifier JW use is now mandatory for reporting drug waste to Medicare?

Louisiana Subscriber

Answer: No. Your contractor still has discretion over whether to require JW (Drug amount discarded/not administered to any patient).

Support: Article MM6711 (www2.cms.gov/MLNMattersArticles/downloads/MM6711.pdf) is a summary of the official instruction,Transmittal 1962, CR 6711 (www.cms.gov/Transmittals/downloads/R1962CP.pdf). This recent transmittal specifically states, "When processing claims for drugs and biologicals (except those provided under the Competitive Acquisition Program for Part B drugs and biologicals (CAP)), local contractors may require the use of the modifier JW to identify unused drug or biologicals from single use vials or single use packages that are appropriately discarded" (bold added for emphasis).

If your contractor requires JW, the transmittal adds some examples to help you use the modifier properly:

Example 1: A single-use vial contains 100 units. The patient receives 95 units, and your practice discards the remaining 5 units. Report the 95 unit dose on one line and the discarded 5 units on another line with JW appended to the drug code:

XXXXX, 95 units

XXXXX-JW, 5 units.

Example 2: The code definition of the single-use-vial drug administered indicates that one unit equals 10 mg. The nurse administers 7 mg and discards 3 mg. Report a single line item showing a single unit only:

XXXXX, 1 unit.

For Example 2, you should not report one unit for the 7 mg administered and another unit (with JW) for the 3 mg discarded because that would result in payment for two units. One unit (10 mg) equals the amount administered plus the amount discarded, so a single unit is sufficient.

Rule: "When the billing unit is equal to or greater than the total actual dose and the amount discarded, the use of the JW modifier is not permitted," the transmittal explains.

The transmittal updates Medicare Claims Processing Manual,chapter 17, section 40 (www.cms.gov/Manuals/IOM/list.asp), and is effective July 30, 2010.