Pulmonology Coding Alert

Question: What is the best way to use the JW Modifier?

Texas Subscriber

Answer: Modifier JW (Drug amount discarded/Not administered to any patient) is a level II HCPCS modifier. This is basically for identifying and reporting the portion of unused drug. As of now, the reporting of this modifier is based on the discretion of the MACs.

However, CMS has disseminated guidelines wherein from January 1, 2017 onwards, you will need to report this modifier as per CMS revised guidelines, to ensure uniformity in the reporting of this modifier.

Use this modifier to report the amount of drug left over in the single use vial/package after administering the requisite amount to the patient. Bill this modifier on a separate line, so as to get reimbursement for this discarded portion of the drug too.

For instance: You have a single use vial with 20 ml of a drug. You deliver 15 ml to a patient, and need to discard the remaining 5 ml. If the billing requires you to report the drug "per ml," you will bill for the 15 units on one line, and the discarded 5 units on a separate line, appending the JW modifier.

Remember: Keep these thumb rule in mind while using the modifier:

• You may not use this modifier in context with usage of drugs and biologicals covered under Competitive Acquisition Program for Part B drugs and biologicals (CAP).
• You may not use this modifier for multiple use vials.
• The actual dose of the drug should not be less than the least billable unit. In this case, just bill the least billable unit, which will cover the entire drug amount, used or unused, without the modifier. For example, if a drug is billed "up to 10 mg" and you only use 7 mg. You are being paid "up to 10" so you would not report the wasted 3mg as a separate line item.
• Remember the documentation requirements, such as updating the accurate amount of unused drugs on patient records, apart from the amounts of drugs administered.