Coding

The American Medical Association has issued a new Current Procedural Terminology (CPT) code for influenza vaccine Flucelvax.

The code — CPT 90674 — went into effect on August 1, 2016, for Medicare claims. However, as the Centers for Medicare & Medicaid Services states, Medicare claims processing systems will not be able to accept the new code until January 1, 2017.

Until the start of the new year, you may hold claims containing CPT 90674. Alternatively, Medicare Administrative Contractors (MACs) may direct use of a Not Other Classified (NOC) code to allow billing for the vaccine for dates of service on or after August 1, 2016, and before January 1, 2017.

CMS advises providers to check with their MAC for this information and other interim billing instructions.

Note: If you bill institutional claims, CMS noted that code CPT 90674 will be implemented on February 20, 2017.

The Centers for Medicare & Medicaid Services (CMS) has issued a change in policy regarding the use of the -JW modifier for discarded Part B drugs and biologicals.

The -JW modifier identifies "Drug amount discarded/Not administered to any patient."

Effective Jan. 1, 2017, providers will be required to:

  • use the -JW modifier for claims with unused drugs or biologicals from single-use vials or single-use packages that are appropriately discarded (except those provided under the Competitive Acquisition Program (CAP) for Part B drugs and biologicals); and
  • document the discarded drug or biological in the patient's medical record when submitting claims with unused Part B drugs or biologicals from single-use vials or single-use packages that are appropriately discarded

The -JW modifier is not used on claims for CAP drugs and biologicals.

CMS indicated it is revising this policy to require the uniform use of the -JW modifier for all claims with discarded Part B drugs and biologicals in order to more effectively identify and monitor medical billing and payment for discarded drugs and biologicals.

X