Medicare Compliance & Reimbursement

Reader Question:

Learn Foolproof Drug Wastage Calculation

CMS offers guidance for this tricky task Question: When we code for drug wastage, I'm always concerned we'll make an error. I have heard that there is an easy way to accurately calculate wastage. Can you shed any light on this? Answer: The key to accurately calculating drug wastage begins with knowing which drugs are single-dose vials and when you should expect waste to occur. There is a simple formula you can use that applies to all drugs from a single-dose vial: Step 1: Add the dose given and the amount wasted to determine the total amount. Step 2: Divide the total amount by the drug's billable unit to determine the quantity of units you should bill. Example: The doctor administers 125 mg of oxaliplatin to the patient (J9263, Injection, oxaliplatin, 0.5 mg), using three 50-mg single-dose vials. Here's how you'd calculate your drug wastage: Step 1: 125 (mg given) + 25 (mg wasted) = 150 (total mg) Step 2: 150 (total mg) divided by 0.5 mg (oxaliplatin's billable unit) = 300 (total units billed) Experts note: According to the CMS Web site, if you use a single-dose vial on multiple patients, you should assign the remaining waste to the last patient on whom you use the single-dose vial. Remember: When you only use the same vial on a single patient, you will also need to bill it entirely to that single patient. You should never report waste on multi-dose vials.
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in Revenue Cycle Insider
  • 6 annual AAPC-approved CEUs
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more