Neurology & Pain Management Coding Alert

Question: My neurologist scheduled two patients back-to-back for botulinum type B injections. But he didn't use all of the Botox and we disposed of it. Do I need to report the wastage when my neurologist doesn't use the entire amount of botulinum toxin? If so, how do I report the wastage?

Nevada Subscriber

Answer: Yes, you can typically bill for botulinum toxin waste.

If you split the vials between patients, bill for the exact units given per patient. If your provider has some leftover, bill for the total number of units used. Then you document the number of units that had to be wasted or discarded on the final patient.

In your example, you might report 64613 (Chemodenervation of muscle[s]; neck muscle[s] [e.g., for spasmodic torticollis, spasmodic dysphonia]) for one procedure, and report 64614 (... extremity[s] and/or trunk muscle[s] [e.g., for dystonia, cerebral palsy, multiple sclerosis]) for the other.

Say your physician has botulinum type B (10,000 units) on hand for the procedures and administers the drug as follows:

• Patient A receives 4,000 units of botulinum B
• Patient B receives 4,000 units of botulinum B with 2,000 units of unavoidable wastage.

Report 40 units of J0587 (Injection, rimabotulinumtoxinB,100 units) for patient A and 60 units of J0587 for patient B -- 40 for the injection plus 20 for the wastage.

Watch out: There are a few payers that require the wastage to be reported on a separate line item with the modifier JW (Drug amount discarded/not administered to any patient) appended. For the payers that require the separation, report the injected 40 unit of J0587 on one line item and the wasted 20 units of J0587-JW on a second line item for this example.

Your provider's documentation needs to show the exact dosage of the drug injected and the exact amount and reason for the unavoidable wastage. You may also have to follow certain payer instructions to attain reimbursement.

Bottom line: Check with your payers to learn their specific policy on coding wasted drugs.