When CMS debuted the JZ modifier last November, the agency gave practices until July 1 to start using it, allowing for a brief period so billers could get to know how the modifier worked. Unfortunately, some practices aren’t yet using modifier JZ, which could mean trouble starting in October—at which point Medicare payers will start denying claims that don’t include it.
Check out a few must-know tips about the JZ modifier so you don’t face a stack of denials on Oct. 1, 2023.
Modifier JZ Describes Zero Drug Wastage
Newly-enacted modifier JZ has the following descriptor: Zero drug amount discarded/not administered to any patient. The point of the modifier is to tell the payer whenever your provider administers a vial of single-dose medication without any wastage.
While your practice may be very familiar with modifier JW (Drug amount discarded/not administered to any patient), that classic modifier essentially has the opposite intent of the new modifier JZ. You use modifier JW when you throw out part of a vial of medication, whereas JZ indicates that none was thrown out.
All Single-Use Vial Claims Must Have JZ or JW
Practices that haven’t been consistent about using modifier JW will have to up their games. In the past, if you didn’t use modifier JW, the payer essentially assumed that you didn’t waste any medication. Now, however, you must append either JW (for wastage) or JZ (for no wastage) if you don’t want to face denials. This applies to all single-dose vials, even those that never produce waste.
For instance, if you administer a whole vial of medication and don’t waste any, you’ll report that drug’s HCPCS code on the claim with modifier JZ appended.
If, however, you administer four units of a five-unit vial to a patient and discard the remaining unit, you’d report four units of the appropriate HCPCS code on one line item. On the next line item, you’d report one unit of the same J code, with modifier JW appended.
If, however, you’re administering a drug that comes from a multi-use vials, these modifiers are not necessary. For multi-use vials, you’ll simply bill for the exact amount you administer for each patient.
Create a Staff Education Session
staff members aren’t up to speed on billing for single-unit drugs, it’s a good idea to have an educational session where you share examples of how to report these services with the appropriate modifiers. During the training event, it’s important to showcase examples using the types of drug your practice administers most frequently. For instance, if you’re a rheumatology practice, consider demonstrating examples with arthritis drugs rather than cancer drugs so your employees better grasp the topic.
Get more information about modifiers so you can collect every penny you’re due. Join expert Dreama Sloan-Kelly, MD, CCS, CPC during her one-hour online training, Modifier 59: Proven Strategies to Boost Pay & Halt Denials. Watch it on-demand at your convenience!
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