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Coding

Update on Policy for Using Modifiers JW and JZ

Discarded Drugs from Single-Dose Containers

JW has been a requirement since 2017; however, Medicare is using the JW modifier and JZ modifier to calculate discarded drug refunds, effective January 1, 2023.

But did you know that as of July 1, 2023, providers and suppliers are required to report the JZ modifier on all claims that bill for drugs from single-dose containers that are separately payable under Medicare Part B when there are no discarded amounts?

Overview: About JW and JZ

The JW and JZ modifier policy applies to all providers and suppliers who buy and bill separately payable drugs under Medicare Part B.

The use of these modifiers is not appropriate for drugs that are from multiple dose containers.
The JW and JZ modifiers are not required for vaccines described under section 1861(s)(10) of the Act that are furnished from single-dose containers.

The JW and JZ modifiers are mostly reported on claims from the physician’s office and hospital outpatient settings for beneficiaries who receive drugs incident to physicians’ services. The JW and JZ modifier requirements also apply to Critical Access Hospitals (CAHs), since drugs are separately payable in the CAH setting. The modifiers may also apply to some drugs furnished by suppliers, such as pharmacies.

HCPCS Modifiers JW and JZ

Since January 1, 2017, when a provider must discard an amount of drug from a single-dose container after administering a dose to a Medicare beneficiary, the Medicare program provides payment for the discarded amount, as well as the dose administered. Amount paid is up to the amount of the drug indicated on the vial or package labeling.

To get reimbursed, this is reported by appending modifier JW on the "J" HCPCS code on the claim.

JW - Drug amount discarded/not administered to any patient:

Now, the discarded amount is any amount that is not part of the prescribed dose and not intended to have a therapeutic effect in the patient.
Even if certain amounts are extracted from the vial or are required to be in the vial to administer the prescribed dose, Medicare does not consider them to be used if they are not intended for therapeutic effect as part of the prescribed dose.
Documentation must be present in the patient’s chart in the event of a CMS audit.

The JW modifier must not be used to report discarded amounts of overfill, which is any amount of drug greater than the amount identified on the package or label.

New as of January 1, 2023: JZ Modifier

The JZ modifier is a HCPCS Level II modifier reported on a claim to attest that no amount of drug was discarded and eligible for payment. The modifier should only be used for claims that bill for single dose container drugs.

JZ - Zero drug amount discarded/not administered to any patient:

To align with the JW modifier policy, the JZ modifier is required when there are no discarded amounts of a single-dose container drug for which the JW modifier would be required if there were discarded amounts.
It is appended to the "J" HCPCS code on the claim.

Read CMS's updated JW and JZ Modifier FAQs; see questions 18-22 which address the hospital outpatient and ASC settings for additional clarity on billing with these modifiers.

Additional Resources

CMS posted a new list of billing and payment codes only used for single-dose containers that may require the modifiers, depending on the setting.

Watch the Modifier Video posted to the AIHC YouTube Channel entitled, "Injections Part 2 Charging for Wasted Medication and CMS Appropriate Use of Modifier JW."

By AIHC

AIHC is licensed as a healthcare education corporation with the Internal Revenue Service (IRS) operating as a Non-Profit 501(c)(3) organization. This means monies earned through the operations of AIHC are reinvested back into the company to benefit our members.

https://aihc-assn.org/

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Concurrent Critical Care:A great deal of time was spent this year with new coding updates focusing on critical care split shared updates, but not much time was given to all of the other red-lined updates in the critical care section of the CMS Claims Processing Manual.

Coding

Staying Dry After Prostate Surgery:When a male patient is diagnosed with prostate cancer and undergoes a radical prostatectomy, he may develop urinary incontinence. This can be a devastating and emotional experience for the patient. The incontinence is caused by the treatment of the prostate and is predictable and possibly preventable.

Coding

Understanding the Long List of Prolonged Services in 2022 and Beyond:Prolonged services have been around for a long time - no pun intended - but in recent years, the number of codes involved has grown and their requirements have changed, making them a potentially risky area for providers.

Coding

AMA Announces CPT Update for COVID-19 Booster Candidates:The American Medical Association (AMA) today announced an editorial update to Current Procedural Terminology (CPT®), the nation's leading medical terminology code set for describing healthcare procedures and services, that includes newly assigned provisional CPT codes for COVID-19 booster candidates from Pfizer and Sanofi-GlaxoSmithKline.

Coding

Substance Use Disorder Treatment Incentive Program Receives Go Ahead from the OIG:Creating incentives for individuals participating in a substance use disorders (SUD) program has always been challenging due to concerns over violating Federal laws such as the Anti-Kickback Statute (AKS) and the Beneficiary Inducements Civil Monetary Penalties.

Coding

Considering the Impact of Diagnosis Codes in the E/M Encounter:It has been nearly seven years since the United States implemented ICD-10-CM, and along the way, we have become better at infusing clinical documentation with the details that allow for assignment of high-specificity ICD-10-CM codes.

Coding

Pinpointing Correct Coding for Anesthesia in Abortions:Medical terminology related to abortions can be puzzling, but it is essential to understand the differences. Having a clear comprehension of several abortion terms is a vital component to achieve successful coding.