Wiki Drug Loss modifier JW help please!

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1formissy

1formissy

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I received a claim from a provider's office who is billing J0585 x 155 units. The medical record shows a TOTAL drug distribution of 155 units, and 45 units with a JW modifier.
If the provider administered a TOTAL of 155 units, shouldn't it be billed
J0585 X110 units
J0585-JW x45 units

My second question is, what would be the reimbursement for the J0585-JW if anything ?


Thank you!:confused:
 
1formissy said:
I received a claim from a provider's office who is billing J0585 x 155 units. The medical record shows a TOTAL drug distribution of 155 units, and 45 units with a JW modifier.
If the provider administered a TOTAL of 155 units, shouldn't it be billed
J0585 X110 units
J0585-JW x45 units

My second question is, what would be the reimbursement for the J0585-JW if anything ?


Thank you!:confused:
Click to expand...

You actually add the 2 lines together...155 injected (sounds like it is for migraine, we do the same procedure here in my clinic), plus the 45 units waste, equals 200 units. Botox comes in 100-unit vials, so 2 vials were used, for a total of 200 units. Providers are encouraged to schedule patients together so that remaining units can be used instead of wasted, but that isn't always possible. We get reimbursed by all payers for the full vials, even if part is wasted. The MAC for your area may offer guidance as well.

HTH!!
 
Hi Meagan,

Yes this information DOES help. Yes, you are correct, this is for a patient with migraines.
Being on the other side as a payer, I want to make sure not only are claims reported correctly, but also that we pay correct as well !
Thank you again! ;)
 
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