by Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
March 7th, 2016
When a portion of a drug must be discarded, Medicare allows payment for amount administered as well as the discarded portion. Your Medicare carrier may require you to use modifier JW. The JW modifier is to be applied only to the portion discarded. Multi-use vials are not subject to payment for discarded amounts.
Take a look at some examples from the AMA:
Can you round up to the nearest whole number when 2 mg of a drug is administered, and the code descriptor specifies up to 10 mg?
Yes. For example, HCPCS code J2270, Injection, morphine sulfate, up to 10 mg, would be reported as 1 unit for the number of milligrams administered up to 10. If 2 mg were administered, report HCPCS code J2270 one (1) time.
HCPCS code J9265; Injection, paclitaxel, 30 mg, should be reported four (4) times if 100 mg were administered.
Please note, units of drugs should be reported based on the way the drug is administered to the patient, not on the way it is packaged, stored or stocked. When the drug dosage amount provided to the patient is greater than the amount indicated for the drug HCPCS code, the reported units should be rounded up. When the drug dosage amount is less than the amount indicated for the drug HCPCS code, use 1 as the unit of measure.
Our doctors inject patients with Kenalog, J3301, Injection, triamcinolone acetonide, not otherwise specified, 10 mg, and other steroid injections. If a patient is injected bilaterally in the knee, hip, or shoulder, do we report the J code as unilateral or as a unit of 2?
The HCPCS J-code would be reported for the drug/substance administered. For example, a 40 mg/ml injection of Kenalog being administered, report J3301, "Injection, triamcinolone acetonide, not otherwise specified, 10 mg", x four (4) units. The appropriate code from CPT code range 20600–20610 (joint injection) would be reported for the injection administration/procedure.
How do you report units of a “Not Otherwise Classified” drug?
When reporting a “Not Otherwise Classified” or “NOC” drug, such as HCPCS code J3490, Unclassified drugs, or J8499, Prescription drug oral, nonchemotherapeutic, NOS, the following should be indicated in either the electronic narrative or Item 19 of the CMS-1500 form:
- Name of the drug
- Total dosage actually administered
- The method of administration
List the number of units of service as “1.”
Hospitals should make sure that no other appropriate unlisted/NOC HCPCS code describes the drug that is reported since there are several unlisted drug HCPCS codes that exist to date.
|HCPCS code||Long descriptor|
|C9399||Unclassified drugs or biologicals|
|J0220||Injection, alglucosidase alfa, 10 mg, not otherwise specified|
|J0256||Injection, alpha 1 proteinase inhibitor (human), not otherwise specified, 10 mg|
|J0833||Injection, cosyntropin, not otherwise specified, 0.25 mg|
|J1566||Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg|
|J1599||Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg|
|J3301||Injection, triamcinolone acetonide, not otherwise specified, 10 mg|
|J7192||Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified|
|J7199||Hemophilia clotting factor, not otherwise classified|
|J7599||Immunosuppressive drug, not otherwise classified|
|J8498||Antiemetic drug, rectal/suppository, not otherwise specified|
|J8499||Prescription drug, oral, non-chemotherapeutic, not otherwise specified|
|J8597||Antiemetic drug, oral, not otherwise specified|
|J8999||Prescription drug, oral, chemotherapeutic, not otherwise specified|
|J9020||Injection, asparaginase, not otherwise specified, 10,000 units|
|J9999||Not otherwise classified, antineoplastic drugs|
|Q2050||Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg|
|Q2051||Injection, zoledronic acid, not otherwise specified, 1 mg|
In addition, for drugs that have multiple HCPCS codes, be sure you are using the correct code. Take a look at J0220 and J0221 for example; both describe an alglucosidase alfa drug, however, HCPCS code J0221 should only be reported for the brand name Lumizyme, while HCPCS code J0220 should be reported for all other alglucosidase alfa drugs.