Oncology & Hematology Coding Alert

Question: If a patient has an intraperitoneal saline drip started and carbo was to be put into the drip but the port was nonfunctioning, can we bill for the carbo? The carbo was pulled from the pharmacy and ready to be administered. The port malfunction was noticed while the saline was being administered before the carbo was started. Please advise if we can charge for saline and administration of saline only with no carbo charges.

Codify Subscriber

Answer: You cannot bill for the drug or biological if none has been administered to the patient. This seems to be case for the carboplatin described by you. As none of it was administered, you will bill only for the saline.

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The rule: According to Medicare, you can bill for the amount of drug discarded as well as the dose administered, up to the amount of the drug indicated on the vial or package label when the physician or provider discards the remaining drug in a single use vial or other single use package.

Before you bill for a discarded drug, you should make sure you have documentation in support of the following:

• The drug or biological was supplied in a single use vial or package
• The amount of drug or biological ordered and administered
• Condition for which the drug or was indicated in the physician’s order
• The amount of drug or biological that is wasted

You also wouldn’t report a wasted amount if the portion of a single dose vial was administered to another patient.

Check for JW modifier: For SDV vial drugs, you may append modifier JW (Drug amount discarded/not administered to any patient) to indicate some of the drug or biological was discarded or not administered to the patient.

Check your payer’s preferences for use of JW. For instance, they may ask that you report the drug amount administered on one line, and on a separate line, report the amount of drug NOT administered or wasted, with modifier JW appended to the relevant HCPCS code. Or the payor may require you to report the total amount on a single line with a modifier JW — but this is now much less common.