PROPOFOL JZ AND JW MODIFIER
I am a charge analyst with a Critical Access Hospital. When utilizing PROPOFOL (J2704) in the surgical setting, the drug is being billed with the JZ and JW modifier based on logic within our Epic Willow system. We are getting payors taking back payment made when we submit the JW on propofol. I feel that the propofol we use during the surgical encounter should be billed as one line with ONLY the amount that was administered to the patient (and no modifiers at all). My understanding is that the JW and JZ modifiers are to be reported with non-pass through meds AND only single use vials. Please give me your thoughts. Thank you.
Sign In to comment.
Comments
You are correct. The JW/JZ modifier only applies to single dose vials (SDV) with a status indicator of G or K in the outpatient setting. Since J2704 has a status indicator of N, the JW/JZ modifier requirement does not apply.
Below is a link to an excellent resource from CMS.
https://www.cms.gov/medicare/medicare-fee-for-service-payment/hospitaloutpatientpps/downloads/jw-modifier-faqs.pdf
Thank you for the reply!