Question
Our facility is trying to confirm if a JW modifier should be used when waste is created due to an adverse drug reaction. We are having trouble finding something from Medicare that addresses this. Would you happen to have any guidance?
Answer
When chemo infusions are started but stopped prematurely, bill only for the services and the amount of the drug actually provided and use specific modifiers for the wasted drug and discontinued procedure.
Document the actual time the drug was administered.
Append a modifier for discontinued procedure (facility -74 and non-facility -52)
Bill for the discarded amount - If the drug came from a single-dose vial and an unused or discarded amount remains that is eligible for separate payment. Report a separate line item for the discarded amount using the same HCPCS code and append modifier JW. Only indicate the waste on this line on the claim.
Documentation is critical.
If the reason is the infusion was discontinued because the patient stopped the infusion and left, that should be documented.
Indicate the total amount of drug in the vial and the amount administered to the patient.
Start and Stop times of the infusion are very important.
Type "documentation available upon request" in box 19 of the CMS 1500 form.
https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=53778