Cardiology Coding Alert

Question: If we have a 90-mg vial of Adenosine and use only 30 mg on the Medicare patient, should we bill the whole vial and note the 60-mg wastage? Or should we bill what's used and use the same vial on the next patient?

Oregon Subscriber

Answer: Medicare guidelines state that you should report a single unit of the drug when the physician supplies less than the dosage listed in its definition. For example, if your cardiologist only administers 20 mg of Adenosine, you should still report J0152 (Injection, adenosine for diagnostic use, 30 mg).

Medicare also specifies that your practice can bill for the amount of drug discarded after the physician performs the test. But memos urge practices to schedule tests in a fashion that minimizes the amount of drug you must discard.

While Medicare specifies that you can share a vial among many patients, the package inserts for these drugs contradict this guidance. The inserts are labeled and packaged as "single use" vials. Physician practices that strive to minimize waste by sharing vials among patients may be exposing themselves to malpractice risks (the risk of contamination increase after someone opens the vial).

You must also make sure that you don't bill twice for the same dose of any drug; this would be a classic example of "double-billing." So practices usually stock 30-mg vials of Adenosine to provide ultimate flexibility with minimal waste.