Simone Posted Tue 21st of December, 2010 19:53:17 PM
Is JW modifier appropriate to use with HCPCS
A9579? I have a provider billing
A9579 with 10 units and
A9579-JW with 5 units.
SuperCoder Answered Wed 22nd of December, 2010 16:14:42 PM
I suggest you first to know the concept on the usage of JW modifier.
Refer to CMS link:http://www.cms.gov/manuals/downloads/clm104c17.pdf
The following details are there in the CMS link:-
40 - Discarded Drugs and Biologicals
(Rev. 1962, Issued: 04-30-10, Effective: 07-30-10, Implementation: 07-30-10)
The CMS encourages physicians, hospitals and other providers and suppliers to care for and administer to patients in such a way that they can use drugs or biologicals most efficiently, in a clinically appropriate manner.
When a physician, hospital or other provider or supplier must discard the remainder of a single use vial or other single use package after administering a dose/quantity of the drug or biological to a Medicare patient, the program provides payment for the amount of drug or biological discarded as well as the dose administered, up to the amount of the drug or biological as indicated on the vial or package label.
When processing claims for drugs and biologicals (except those provided under the Competitive Acquisition Program for Part B drugs and biologicals (CAP)), local contractors may require the use of the modifier JW to identify unused drug or biologicals from single use vials or single use packages that are appropriately discarded. This modifier, billed on a separate line, will provide payment for the amount of discarded drug or biological. For example, a single use vial that is labeled to contain 100 units of a drug has 95 units administered to the patient and 5 units discarded. The 95 unit dose is billed on one line, while the discarded 5 units may be billed on another line by using the JW modifier. Both line items would be processed for payment.
The JW modifier is only applied to the amount of drug or biological that is discarded. A situation in which the JW modifier is not permitted is when the actual dose of the drug or biological administered is less than the billing unit. For example, one billing unit for a drug is equal to 10mg of the drug in a single use vial. A 7mg dose is administered to a patient while 3mg of the remaining drug is discarded. The 7mg dose is billed using one billing unit that represents 10mg on a single line item. The single line item of 1 unit would be processed for payment of the total 10mg of drug administered and discarded. Billing another unit on a separate line item with the JW modifier for the discarded 3mg of drug is not permitted because it would result in overpayment. Therefore, when the billing unit is equal to or greater than the total actual dose and the amount discarded, the use of the JW modifier is not permitted.
The JW modifier is not used on claims for CAP drugs. For CAP drugs, see subsection 100.2.9 - Submission of Claims With the Modifier JW, “Drug or Biological Amount Discarded/Not Administered to Any Patient”, for additional discussion of the discarded remainder of a vial or other packaged drug or biological in the CAP.
NOTE: Multi-use vials are not subject to payment for discarded amounts of drug or biological.
Simone Posted Wed 22nd of December, 2010 20:41:11 PM
Thanks for the link but I'm looking for an updated list that tells me JW modifier cannot be used with
SuperCoder Answered Thu 23rd of December, 2010 15:37:03 PM
Yes, you can use modifier JW with A9579. You can refer to sites of local contractors or get info from your local contractor policy of the reason why local contractors require the use of the modifier JW for A9579 to identify unused drug or biologicals from single use vials or single use packages that are appropriately discarded.
Simone Posted Mon 27th of December, 2010 22:13:02 PM