Coding & Compliance - May 2010
“DISCARDED DRUG AND BIOLOGICALS UPDATE”
CMS has issued guidance on self-administered drugs.
On April 30, 2010 CMS issued a transmittal (CMS Transmittal 1962) to clarify what “administered” means in the context of self-administered drug determinations.
The term “administered” refers only to the physical process by which the drug enters the patient’s body. It does not refer to whether the process is supervised by a medical professional (for example, to observe proper technique or side-effects of the drug). Injectable drugs, including intravenously administered drugs, are typically eligible for inclusion under the “incident to” benefit. With limited exceptions, other routes of administration including, but not limited to, oral drugs, suppositories, and topical medications are considered to be usually self-administered by the patient.
Effective date: July 30, 2010
Implementation date: July 30, 2010
When processing claims for drugs and biologicals (except those provided under the Competitive Acquisition Program (CAP), for Part B drugs and biologicals), local contractors may require the use of the modifier JW to identify unused drug or biologicals from single use vials or single use packages that are appropriately discarded. This modifier, billed on a separate line, will provide payment for the amount of discarded drug or biological. For example, a single use vial that is labeled to contain 100 units of a drug has 95 units administered to the patient and 5 units discarded. The 95 unit dose is billed on one line, while the discarded 5 units may be billed on another line by using the JW modifier. Both line items would be processed for payment.
The JW modifier is only applied to the amount of drug or biological that is discarded. A situation in which the JW modifier is not permitted is when the actual dose of the drug or biological administered is less than the billing unit.
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If you have any questions or need additional information regarding this article please contact Cindy Tipton at Cindy_Tipton@MED3000.com
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