Health Information Management

Q/A: Correct use of modifier -JW

APCs Insider, September 10, 2010

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Q: We’ve been hearing about CPT modifier -JW (drug amount discarded/not administered to any patient). How does this affect outpatient Medicare billing?

A: Review Change Request (CR) 7095, which was issued in response to inquiries related to CR 6711, which relates to the use of modifier –JW for discarded drugs and biologicals.
CMS instructs that each Medicare contractor (FI/MAC):

  •  Has individual discretion to determine whether modifier -JW is required for any claims with discarded drugs, including specific details rregarding the actual documentation of the amount of drug discarded, and applied on the claim
  • Will notify their respective providers of such requirements associated with use of modifier -JW

Most FI/MACs have made it abundantly clear that whether they require JW for reporting purposes or not, documentation of the discarded amount must be present in the patient’s record.

Work closely with your revenue cycle, including pharmacy and clinicians, to ensure medical record documentation includes this information and can be produced upon audit. In addition, review your Local Coverage Determinations, particularly those related to drugs and skin substitutes as they include additional instructions regarding modifier JW and documentation requirements.
 



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