Adjust to Modifier JW Change by January (Not July)

By Susan Dooley

For years, Medicare has had a rule that lets local MACs decide whether their providers have to
usemodifier JW (Drug amount discarded/not administered to any patient). All that is about to change.
Effective Jan. 1, 2017, Medicare will require modifier JW use by all providers for discarded Part B drugs
and biologicals. The implementation date is Jan. 3. (Medicare originally stated July 1, 2016, was the
effective date, but recently announced a revision changing the date to Jan. 1.)

Focus on When JW Applies to Avoid Misuse

If your MAC already requires you to use modifier JW, then you may not have much to change. But if you
havent been using the modifier, be sure you dont miss these rules.

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com

Use JW for claims with unused drugs or biologicals that meet these conditions:

From single-use vials or single-use packages

Appropriately discarded
Not provided under the Competitive Acquisition Program (CAP) for Part B drugs and biologicals.

Important: CMS requires documentation of the discarded drug or biological in the patients record, so be
sure that information is present before you submit the claim for the unused portion.

Increase Your Understanding With 2 Examples

To be sure youre using modifier JW appropriately, review these examples based on the ones CMS
provides in the updated version of the Medicare Claims Processing Manual, Chapter 17, Section 40.
When using JW, youll report separate line items for the amount administered and the amount
discarded, as shown in Example 1. (Theres an exception to watch for, too, shown in Example 2.)
Example 1: A single-use vial label shows it has 100 units of a drug. Lets say the code is Jxxxx, and you
report 1 billing unit per drug unit based on the code descriptor. The nurse documents administering 95
units to the patient and discarding 5 units. You should report:

Jxxxx, 95 units
Jxxxx-JW, 5 units.

Medicare will process both lines for payment, so you can rest easy on that point.
Example 2: A single-use vial label shows it has 10 mg. Lets say the code is Qxxxx, and you report 1 billing
unit per 10 mg based on the code descriptor. The nurse documents administering 7 mg to the patient
and discarding 3 mg. Because 1 billing unit is equal to 10 mg, you should report only 1 billing unit:

Qxxxx, 1 unit.

Rationale: If you reported 1 unit for the 7 mg administered on one line item and 1 unit with JW for the 3
mg wasted on another line item, youd be billing 2 units and getting paid for 20 mg instead of 10 mg.
Thats overreporting and would lead to overpayment.
Bottom line: Put your math skills to work. If the billing unit is equal to or greater than the total of the
amount administered plus the amount wasted, you should not use modifier JW.

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com

How About You?

We all know how important proper modifier use is to a clean claim. Are you worried about having to
apply this new universal rule for modifier JW?

Stay Up-to-Date With Part B Coders News, Tools, and Code Sets
To be sure you dont miss important updates like this modifier JW change, take advantage of the weekly
newsletters from Part B Coder. Youll stay on top of the latest news, plus have access to SuperCoders
powerful combination of code search and compliance tools! Contact us for a free copy today!

Contact Us:
Name: Sam Nair
Title: Associate Director
Email: shyamn@codinginstitute.com
Direct: 704 303 8150

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com