for contents lost as a result of preparation.
Providers must use the smallest package size available from the manufacturer
or the package size that is the closest to
the patient’s prescribed dosage amount.
Documentation of both the administered
portion and the discarded portion of the
drug/biological must be included in the
patient’s record. When billing for the discarded drug/biological, a line item for the
discarded amount with the –JW modifier
appended in addition to a line item for
the administered amount (with no –JW
modifier) is required unless, together, these
amounts are less than the HCPCS dosage
definition assigned to that drug/biological.
Use of the –JW modifier does not apply to
drugs/biologicals that are: (1) drawn from
multi-dose vials, ( 2) submitted on inpatient
claims, or ( 3) not separately payable (such
as those assigned to Outpatient Prospective
Payment System status indicator N). 3
Providers across the healthcare industry
continue to face many operational challenges related to the supply, documenting,
and billing of discarded drugs/biologicals.
Several questions need to be asked when
assessing your organization’s internal
operational processes as they relate to
discarded drugs/biologicals obtained from
How are the single-use packaged
drugs/biologicals ordered and stocked?
Are there multiple package sizes avail-
able from the manufacturer, but only one
size ordered and stocked to allow for dis-
counted purchases in bulk? Does this limit
the availability for providers to select the
most appropriate package size for each
specific patient’s needs?
Are there drugs/biologicals being discarded from single-use packaging when
the entire packaged amount is not administered to the patient?
Who is responsible for documenting the
discarded portion of the drug/biological?
Does the responsibility for documentation
of waste differ depending on location, discipline, or other factor(s)? If so, do all parties
understand their role and its impact with
respect to this process?
Is the waste documentation included as
part of the permanent record?
Is the wasted amount clearly documented
within the patient record? Is it residing in a
separate location that results in an inadvertent omission in the event that a request for
records is received?
How are the charge(s) for the
Are the charges being generated based on
the amount dispensed or the amount documented? Does this process differ depending
on what department or practice is administering the drug/biological? Does this process
differ depending on what drug/biological
is being charged? Once generated, will the
charges fall as separate line items on the
claim when appropriate — one line item
for the administered amount and one line
item for the discarded amount with the –JW
appropriately applied (unless, together, the
administered and the discarded amounts are
less than the HCPCS dosage definition — at
which time only one line item without the
modifier –JW would be appropriate)? Are the