JW modifier and mutlipliers

alysn1drlnd

Networker
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Fayetteville, NC
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Help! Does anyone have any suggestions on where to set the multipliers for the pharmacy codes when the JW modifier comes into affect, or is everyone just doing a manual override/workaround to fix the billing units- for example, J1885 is for 15mg, but my system is trying to drop J1885x10 and J1885-JWx5- and that is not correct- so thinking the multipliers need to be set at 1 and the staff needs to be trained to do the math?! Any suggestions are way more than welcome! Thanks!
 

kmd1965

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decatur, GA
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1. How are your charges posted? Manually, or coming from a Pharmacy EMR?
2. What is the vial size you're actually purchasing, and what do your doses/administrations generally look like?
If you're using a single use vial and use less than 15 mg, you don't have to report the JW modifier.

Never a simple answer with Pharmacy, is there? :)
 

alysn1drlnd

Networker
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Fayetteville, NC
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nope, never is- they are posted by pharm/emr- there is not an actual person that does it- and I did figure out for this particular drug no JW was needed since we gave less than the billing unit..but still not sure if I have multipliers set if it will affect some of the chemo drugs that would need JW modifier- I guess I will have to review each claim as it comes and make adjustments from there. Fun times LOL :)
 

kmd1965

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decatur, GA
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Since you have an EMR, the pharmacy should set the billing unit on the drug to be the HCPCS unit.
They should set the dispensing unit to whatever it is for your organization and that drug.
Since the JW is a Medicare requirement, the vendor should have a mechanism in place that will report the waste appropriately.
 
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