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Answer: The drug is provided in a single-use vial. Therefore, the practice has no other choice but to bill for the whole vial, even though only a portion of it was used.
Each J code represents a specific dosage, and drug manufacturers provide their products in either single-use or multi-use vials. In most cases, the amount contained in each vial corresponds with the dosage delivered, which minimizes waste. The J code corresponds with the vial amount. Single-use vials call for the disposal of the unused portion of the drug if the vial amount does not match the dose.
If the drug is administered from a single-use vial, bill the entire amount in the vial. In other words, report the J code that matches the drug and vial amount.
The reader describes a common single-use vial scenario. The billing unit for Interleukin (J9015) is 18 million units, which is the total dose in a reconstituted vial of Interleukin. The package insert for the drug indicates that this is a "single-use vial" and that "any unused portion should be discarded." Therefore, the appropriate way to bill for Interleukin is to bill the entire amount, even if the drug is not completely used, and then document the waste if required by your Medicare carrier.
To document waste, list the dosage delivered, the vial amount contained in the single-use vial, and the amount wasted.
For drugs that are packaged in multiple-use vials, a practice can only bill for what was administered, because the vial is expected to yield more than one dose. When using multi-use vials, practices should report the quantity most closely associated with the J codes to describe the amount administered. |
