Wiki JW Modifier - any changes on how to use?

[robinpich]

I am new to a practice here in FL, but have been coding for 11 yrs. It is my understanding that the JW modifier is ONLY used on the line item for the wasted drug that was not administered. Is that still correct?

example: J9033 billed at 100 units, patient received 75 units, wasted 25 units.
Originally billed as 100 units on 1 line with JW modifier. Medicare only processed as 10 units and paid. We (Long before my time here) filed an appeal to have Medicare process the additional 90 units. Medicare sent an approval letter that appeal was in our favor but then they only paid the 75 units the patient actually received.

The corrected claim was bill as J9033 x 100 -JW on 1 line, not split on 2 sep lines.

How do I begin to get this corrected?
Oh, it's from 2010 also.

Thanks,Robin

 

[mhstrauss]

I am new to a practice here in FL, but have been coding for 11 yrs. It is my understanding that the JW modifier is ONLY used on the line item for the wasted drug that was not administered. Is that still correct?

example: J9033 billed at 100 units, patient received 75 units, wasted 25 units.
Originally billed as 100 units on 1 line with JW modifier. Medicare only processed as 10 units and paid. We (Long before my time here) filed an appeal to have Medicare process the additional 90 units. Medicare sent an approval letter that appeal was in our favor but then they only paid the 75 units the patient actually received.

The corrected claim was bill as J9033 x 100 -JW on 1 line, not split on 2 sep lines.

How do I begin to get this corrected?
Oh, it's from 2010 also.

Thanks,Robin

From my understanding of the JW modifier, there should be 2 lines billed, the first with how many units the patiently actually recieved, second with how many units were wasted with the JW. Your example would be billed as:

J9033 x 75
J9033-JW x 25



Not all MAC's require it; mine (Novitas) currently does not.

Hope this help!