AMA Clinical Examples in Radiology - 2024 Issue 1 (Winter)
Questions and Answers
Winter 2024 pages 30-35 QUESTIONS AND ANSWERS Question Answer What is the difference between HCPCS modifiers JW and JZ? HCPCS Level II modifiers JW , Drug amount discarded/not administered to any patient , and JZ, Zero drug amount discarded/not administered to any patient , are required by the Centers for Medicare & Medicaid Services (CMS) to report drugs and biologicals that are separately payable under Medicare Part B. Modifier JW must be reported on a claim for the amount of a drug that is discarded and eligible for payment. Modifier JZ is reported to attest that no amount of drug was discarded. Effective...
Subscribe or sign in to view the full article.
Article Overview
This Winter 2024 Questions and Answers article covers a small set of practical medical coding topics for professional coders and billing staff. It discusses Medicare Part B drug reporting requirements, the process used to value new Category I CPT codes, and general considerations for reporting extensive CT and MRI studies. The article also notes the role of CMS, AMA, RUC, and specialty societies in code valuation and related policy guidance.
Why This Topic Matters
The topics affect claim accuracy, payment processing, and understanding of how coding guidance is developed and applied across outpatient and imaging settings. It is useful for readers who need a high-level orientation to Medicare drug modifiers, CPT valuation workflow, and imaging reporting policy.
Article Sections
-
Medicare drug reporting modifiers
Covers a Medicare billing question about reporting discarded and non-discarded drug amounts, including the related compliance context and claim-processing considerations.
-
Valuation of a new Category I code
Explains the general workflow used after CPT Editorial Panel approval, including the involvement of specialty societies, RUC review, and CMS valuation.
-
Reporting whole-body CT or MRI
Discusses general reporting considerations for extensive CT and MRI studies, including how scan scope and contrast status affect code selection and how modifiers may factor into reporting.
What You Will Learn
- How the article frames Medicare drug reporting issues for separately payable drugs
- How new Category I CPT code valuation is reviewed by professional organizations and CMS
- How broad CT and MRI studies are described for reporting purposes
- What organizations are involved in the CPT valuation workflow
- Why imaging scope and institutional protocols can affect reporting considerations
Who Should Read This
- Medical coders
- Billing specialists
- Radiology coding staff
- Physician office staff
- Hospital outpatient billing staff
- Compliance teams
Codes Discussed
Modifiers Discussed
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com
