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 SubscriberAnswer: 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 unitsPatient 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 [...]