Billing for Drug Waste: A Look at the New Modifier – JW

The reporting of new modifier –JW, which specifies the portion of a single dose vial (SDV) or single use package that was not administered to the patient, and which goes into effect July 30, 2010, is optional at this time.  

Medicare guidelines state to report the drug amount administered on one line, and on a separate line you may report the amount of drug NOT administered (wasted) with modifier –JW appended to the associated HCPCS code.

Modifier -JW is only applicable to the amount of the drug discarded or wasted, and not the amount administered. Further, the amount wasted and identified by the use of modifier –JW, must be at least equal to one billing unit. For example, if the HCPCS code is reportable in 10mg increments and you administered 7mg of a 10mg SDV, report the entire billing unit (1) without a separate line for the amount wasted. If, on the other hand, a HCPCS code is reportable in 10mg increments, and you administered 70mg from a 100mg SDV, you may  report 7 bill units as administered, and on a separate line report 3 bill units with modifier –JW appended to the HCPCS to indicate the drug amount discarded.

Use caution – Modifier –JW is not permitted to identify discarded amounts from a multi-dose vial (MDV). In order to ensure you do not receive overpayment, remember to always roll the amount administered UP to the next bill unit, then roll DOWN to the previous bill unit when reporting the amount of drug discarded. For example, if a HCPCS code is reportable in 10mg increments, and you administered 77mg from a 100mg SDV, you may report 8 bill units as administered, and on a separate line report 2 bill units with modifier –JW appended to the HCPCS to indicate the amount discarded.

As always, Medicare expects the administration of drugs to be scheduled and performed in an efficient manner, minimizing the amount of drug wastage.

Refer to CMS Transmittal 1962, Change Request (CR) 6711, issued April 30, 2010, for full text.

Written by: Sandra Inocencio, RN, CCP, CPC