In medical billing and coding, the key that unlocks the door to rightful reimbursements on the first try is called DETAILS. However, the same details can also be the ultimate nightmare for some because it means you must comply with several coding and billing standards and industry regulations. Appropriate modifier usage is one such rule that you cannot ignore.
If you are confused about whether to use the JW or JZ modifier while administering a single dose of vialed, packaged, or contained drug, it is time to dump the worries and up your coding game. In this guide, we will cover everything you need to know about these modifiers.
JW Modifier – Description
The JW modifier must be appended to all medical claims that bill drugs with discarded or unused amounts from single-dose packages, vials, and containers. Besides, the documentation must include the amount of medication injected and wasted. This information should align with the units mentioned on the submitted claim. This modifier became effective on January 1, 2017.
JZ Modifier – Description
The JZ modifier is required on all medical claims that bill single-dose packaged, contained, or vialed medications based on FDA-approved labeling and report no unused or discarded amount (zero wastage). This modifier became effective on July 1, 2023.
Modifiers JW vs JZ – Key Differences
The following table offers an at-a-glance view of how the JW and JZ modifiers differ. It covers the purpose of both modifiers, dose type, drug usage, reporting, and coding examples.
| JZ Modifier | JW Modifier | |
|---|---|---|
| Purpose | It identifies that the entire drug from the vial was utilized. | It indicates that a portion of the drug was discarded or not used. |
| Single/Multi-dose | Single-dose | Single-dose |
| Drug Usage | No drug amount was discarded. | Some drug amount was discarded. |
| Reporting | It requires reporting the total units used (given to the patient) with the modifier in a single line. | It requires reporting the units consumed in one line and units discarded with modifier JW in the second line. |
| Coding Example | The provider injected 500 mg of fluorouracil from a single-dose vial of 500 mg. Thus, the appropriate way to report it will be:• J9190-JZ, 1 unit | From a single-dose Kenalog (triamcinolone) vial of 40 mg, the provider utilized 10 mg and discarded 30 mg. Billing it per 10 mg yield:• J3301, 1 unit • J3301–JW, 3 units |
The above table precisely describes the differences between both modifiers. However, there are also some similarities. For example, some considerations limit the application of these HCPCS modifiers. Here, check it out!
- The JW and JZ modifiers are typically appended on medical claims from hospital outpatient settings and the physician’s office.
- You can also use these modifiers in the Critical Access Hospitals (CAHs) setting because medications are separately payable.
- You cannot append JW and JZ modifiers if drugs are drawn from multi-dose containers.
- You cannot use these modifiers if the clinician has not purchased the medication.
- Avoid appending this modifier if the administered drugs are not payable under Medicare Part B. These include sample medications, ‘white bag’ distribution, or specialty pharmacy drugs.
Scenarios Where Modifiers JW and JZ are Applicable
Here are some practical scenarios to help you gauge how both JW and JZ modifiers differ:
JZ Modifier – Examples
Example # 1
Injection, bevacizumab is billed per 10 mg with HCPCS code J9035. This medicine comes in 100 mg and 400 mg vials, but you can bill it per 10 mg. Consider a scenario where a patient requires 300 mg of the drug. Thus, the healthcare provider utilized 3 x 100 mg vials (30 units), and since there was no wastage, you will report this medication with the JZ modifier.
Example # 2
Assume a patient is diagnosed with age-related macular degeneration (AMD). The clinician is required to administer 6 mg of Vabysmo (faricimab-svoa). It is billed per 0.1 mg with HCPCS code J2777 and comes in a single-dose 6 mg vial. The provider administers all the contents of the 6 mg vial and reports the 60 units with modifier JZ to indicate zero wastage.
Example # 3
A patient diagnosed with glaucoma requires 10 mcg of Durysta (bimatoprost implant). It is a single-dosage flexible, small, and semi-transparent tube. You can bill per 1 mcg with HCPCS code J7351.
Thus, the healthcare provider will report 10 units of J7351 with modifier JZ after implanting the tube. The modifier will indicate that the entire medication was administered to the patient.
JW Modifiers – Examples
Example # 1
Take the injection Avastin’s (bevacizumab) example for the JZ modifier and assume a situation where instead of 300 mg, the patient requires a dosage of 350 mg. Thus, the healthcare provider took a 400 mg vial, utilized 350 mg (35 units), and reported a wastage of 50 mg (5 units) with modifier JW.
Example # 2
The healthcare practitioner diagnosed a patient with age-related macular degeneration (AMD) and prescribed a 12 mg dosage of Visudyne (verteporfin). It comes in a single-dose vial containing 15 mg of medication, and you can bill it per 0.1 mg with HCPCS code J3396.
Thus, after administrating a 12 mg dose, the clinician will report 120 used units without modifier in the first line and 30 discarded units in the second line with modifier JW.
Example # 3
A patient seeking treatment for wrinkles or other cosmetic concerns came for Botox. Thus, the clinician administers 30 units from a single-dose 100-unit box. Since you can bill this medication per 1 unit, the provider will report 30 used units without modifier and 70 discarded units with modifier JW in another line.
Summary
Let’s quickly recap what we discussed in this guide! We discussed JW and JZ modifiers’ descriptions, explaining that you can append a JZ modifier when you administer the entire contents of a single-dose vial, package, or container to the patient. Contrarily, a JW modifier is typically reported when some amount of a single-dose package, vial, or container is wasted. Besides, we shared key differences between JW and JZ modifiers, including their purpose, reporting, and drug usage. Moreover, we discussed some practical scenarios to help you understand their application. Medical coding and billing is a complex process. Thus, if you have trouble understanding the concept of modifiers, you can outsource medical billing to professionals like MediBill MD.
