Pain Management Coding Alert

When you throw Botox A away, try to recoup cost with modifier.

If you aren’t using modifier JW to code for your supplies of discarded/unadministered drugs, you might be leaving deserved reimbursement on the table.

Since Jan. 1, you should have been using HCPCs modifier JW (Drug amount discarded/Not administered to any patient) to indicate when you didn’t use a full vial of a drug such as Botox. If that’s news to you or if you’re in need of a refresher on how to accurately report your drug usage claims — and avoid expensive paybacks to Medicare — we’ve got some recommendations.

The rule:  Effective Jan.1, CMS requires all providers and suppliers “to report the JW modifier on Part B drug claims for discarded drugs and biologicals,” the agency stipulates in its FAQ on the modifier. So, you need to be sure to use JW to get paid for “a discarded amount of drug in single dose or single use packaging under the Medicare discarded drug policy,” says CMS.

Example: Your practice opens a 100-unit single-dose vial of onabotulinumtoxinA reconstituted. Your physician injects a total of 1 unit and documents 99 units of unavoidable wastage. You would bill for the onabotulinumtoxinA as follows:

• J0585 x 1 unit for the used portion of the Botox
• J0585 x 99 units with modifier JW appended for the unused Botox.

Remember: Medicare payers should pony up for any discarded drugs when you code the claim correctly and use modifier JW. Private payers might not follow Medicare’s lead, however. If you have any doubt about whether or not a payer recognizes modifier JW — or allows you to report drug supply wastage — before submitting the claim.

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