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lcole7465

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So, I started coding strictly for a Pain Management practice and I know that we can bill for discarded drugs. I'm not very familiar with billing for these. If anyone has any input/advise or examples of how this billed correctly.

Thanks
 
JW modifier

The JW indicates the wasted amount. It goes on a separate line from the amount given.
On line one of your claim list the J code and the number of units to indicate the dose given. For example if 2 units = 10 mg and only 5 mg was given, put the J code on line one with 1 unit; the second line would be the J code with a JW modifier with 1 unit for the wasted amount.
 
prayercoder said:
The JW indicates the wasted amount. It goes on a separate line from the amount given.
On line one of your claim list the J code and the number of units to indicate the dose given. For example if 2 units = 10 mg and only 5 mg was given, put the J code on line one with 1 unit; the second line would be the J code with a JW modifier with 1 unit for the wasted amount.
Click to expand...

No, that is not quite worded correctly and could be misconstrued or misinterpreted.

Regarding partial units administered. You always round up units as you can't bill fractions of units. Let's take Kenalog. Kenalog (J3301) comes in larger multi-use vials. In other words, you can pull multiple doses/administrations from the same vial. It is not a single-use vial or container. For example, a vial may contain 5 or 10 ml of Kenalog at a concentration of 40mg/ml or 10mg/ml. If one unit of J3301 is 10 mg, and you administer 15 mg, you round up to 2 units (20 mg). You do not use JW in this instance to disclose the rounded up dosage. JW is inappropriate to J3301 as Kenalog isn't distributed in single-use vials.

Here is a JW Modifier FAQ

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Downloads/JW-Modifier-FAQs.pdf

Look at Question 8

Q8. Is the JW modifier applicable when the dose administered is less than the HCPCS billing unit?
A8. CMS does not use fractional billing units to pay for Part B drugs. Therefore, the JW modifier should not be used when the actual dose of the drug administered is less than the HCPCS billing unit.


Let's make the response a little clearer...

JW is used for single use vials when not all of the drug in the vial is administered to the patient.

For example, the single use drug is packaged in a 10 ml vial. You administer 5 ml of the drug, and have to discard the other 5 ml since it's single use. You bill for how ever many units you administer (paying attention to the HCPCS code and dosage per unit) and use JW on the amount you discard.


Here is a JW modifier fact sheet.

https://med.noridianmedicare.com/web/jddme/policies/dmd-articles/jw-modifier-use-010117
 
JW Modifier with TPN??

Any thoughts on whether JW can be used for Lipid waste (B4185)? It looks like lipids are FDA approved drug.. but billed under Bcodes rather than J. Any thoughts?
 
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