Documentation of Discarded Drugs
As described in Chapter 17, Section 40.1 of the Medicare Claims Processing Manual, in addition to paying for the amount of the drug that has been administered to a beneficiary, Medicare Part B also pays for the amount of drug that has been discarded, up to the amount that is indicated on the vial or package label. The discarded drug amount is the amount of a single use vial or other single use package that remains after administering a dose/quantity of the drug to a Medicare beneficiary.
Effective January 1, 2017, providers and suppliers are required to report the JW modifier on Part B drug claims for discarded drugs and biologicals. Also, providers and suppliers must document the amount of discarded drugs or biologicals in Medicare beneficiaries’ medical records.
The JW modifier is a Healthcare Common Procedure Coding System (HCPCS) Level II modifier used on a Medicare Part B drug claim to report the amount of the drug or biological (drug) that is discarded and eligible for payment under the discarded drug policy. The modifier should only be used for drugs in single dose or single use packaging. 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.
The drug discarded should be billed on a separate line with the JW modifier. The unit field should reflect the amount of drug discarded. Please refer to the example in the Medicare Claims Processing Manual Chapter 17, Section 40.
Centers for Medicare and Medicaid (CMS). MLN Matters MM9603; https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9603.pdf; Published June 9, 2016. Accessed July 22, 2019.
Centers for Medicare and Medicaid (CMS). Medicare Program JW Modifier: Drug/Biological Amount Discarded/Not Administered To Any Patient Frequently Asked Questions; https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Downloads/JW-Modifier-FAQs.pdf; Published August 26, 2016. Accessed July 22, 2019.
Ronda Tews, CPC, CHC, CCS-P
DIRECTOR OF BILLING AND CODING COMPLIANCE
Ronda Tews, Certified Professional Coder (CPC), Certified in Healthcare Compliance (CHC), and Certified Coding Specialist-Physician (CCS-P), is the director of billing and coding compliance at Modernizing Medicine® and brings over two decades of robust healthcare compliance experience to the organization. In her current role, she develops and manages the billing and coding compliance program for the company. Ronda performs billing and coding compliance audits among other related functions while maintaining knowledge of current regulatory and compliance guidance.
Prior to her time at Modernizing Medicine, Ronda held various roles such as managing provider compliance for a large health plan in Oklahoma and creating a fraud, waste and abuse program. Ronda’s duties have consisted of conducting E/M audits on physicians and mid-level providers, establishing internal auditing and monitoring, as well as teaching basic coding classes to co-workers and providing E/M documentation training to physicians and mid-level providers. She has also implemented compliance education and training programs, managed the Compliance Report Line as well as compliance auditing and monitoring. Ronda also provided coding and documentation education at Missouri State University to the physician assistant students on an annual basis. Ronda has held various roles such as serving as a Quality Improvement analyst and working as a corporate compliance project manager for a large Mid-Western health system.
Ronda founded the Springfield, MO AAPC chapter where she served as the president and treasurer. She remains very active in the industry as she writes articles for industry publications and can be found speaking at conferences. Connect with Ronda on LinkedIn.