Primary Care Coding Alert

Question: We are unable to purchase the small kid dosage of liquid albuterol (1.25 mg/.25ml) We are therefore using the (2.5 mg/.5ml) but only administering half of the vial (1.25/.25 ML) for the younger kids. This creates 1.25 mg/.25 ml of waste. How do I report this? Also, is modifier JW only for injectable waste?

Oregon Subscriber

Answer: There’s nothing in the descriptor for the JW modifier (Drug amount discarded/not administered to any patient) that suggests it’s for injections only. Medicare’s language in section 40 (Discarded Drugs and Biologicals) of chapter 17 (Drugs and Biologicals) of the Medicare Claims Processing Manual is also general in regard to administration (https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c17.pdf).

So, as long as the drug concentration matches the HCPCs code descriptor for the administered amount, one claim line should include the billing and payment HCPCS code describing the given drug, no modifier, and the number of units administered in the unit field. For the discarded amount, a second claim line should include the same billing and payment code used for the administered amount with the JW modifier appended and the number of units discarded in the unit field.

For example, J7611 (Albuterol, inhalation solution, FDA-approved final product, non-compounded, administered through DME, concentrated form, 1 mg) is for 1 mg. You used more than one unit (1.25 mg.), and you also had waste because it was a 2.5 mg vial. Following the guidance above, you would report J7611 on one claim line without a modifier and 1.25 in the unit field (assuming the payer allows fractional units) and J7611 with modifier JW appended on a second claim line with 1.25 in the unit field for the wastage.

Note: Always remember to document the exact amount wasted when submitting the claim.

Also: Different payers handle wastage differently. Check the payer policy to see what’s allowed.