Neurology & Pain Management Coding Alert

Question: How should I bill for wasted drug? My doctor of ten splits a single vial between two patients, but there is still some leftover. For example, he administers Botox (botulinum type A) using the 100-unit size vial. He splits the injection between two separate patients, administering 40 units to each patient. Can we get reimbursed for the entire amount?

Delaware Subscriber

Answer: To bill for drug wastage some payers may require you to append modifier JW (Drug amount discarded/not administered to any patient) to the code for the wasted drug. For the Botox example you give, you should bill as follows:

Patient 1: J0585 (Injection, onabotulinumtoxinA, 1 unit), 40 units

Patient 2: J0585, 40 units, followed by a separate line item of J0585-JW, 20 units (to represent the wastage).

Caution: Not all payers want you to append modifier JW. For instance, Highmark Medicare Services -- a Part B payer in five states, including Delaware -- notes on its Web site that "reporting the JW modifier is not required." Most payers request that practices document the date, time, amount wasted, and reason for wastage in the patient's medical record. "Upon review, any discrepancy between amount administered to the patient and amount billed will be denied as non-rendered unless the wastage is clearly and acceptably documented," according to a policy on the Web site of Trailblazer Health, a Part B payer in five states. So ensure that your doctor clearly documents the wastage information so you can bill for it and successfully appeal if your claim is denied. q

Clinical and coding expertise for You Be the Coder and Reader Questions provided by Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, owner of MJH Consulting in Denver.