Oncology & Hematology Coding Alert

Answer: Billing for unused drugs depends on whether a drug is contained in a single-dose or multi-use vial. Physicians dont have to absorb the cost of the unused portion, as long as their oncology practices take care in providing the appropriate documentation. If the HCPCS code billing-unit is 10 mg and the drug comes in 20 mg vials, you would bill using the appropriate HCPCS J code for the billing units on the Health Care Financing Administrations HCFA 1500 claim form for Medicare reimbursements.
Date of Service 02/01/00
HCPCS Code J90000
Billing Unit 10 mg
Description Doxovubicin
Units 4

But if you use 1-1/2 vials (30mg) you still are allowed to bill per the HCPCS dose amount.
Date of Service 02/01/00
HCPCS Code J9000
Billing Unit 10 mg
Description Doxovubicin
Units 4

Physicians can only bill for the amount of a drug actually used from a multi-use vial. Therefore, the remaining 10 mg from a multi-use vial is wasted if the drug cannot be used for a patient who requires that dosage. The unused portion of the multi-use vial can be used on the same patient. If the patient, however, requires less than the dose amount in the vial, the remainder is nonbillable waste.

To determine whether a drug is contained in a single-dose or a multi-use vial, look the drug up in the Red Book, which lists U.S. Food and Drug Administration-approved drugs, their dose amounts, and average wholesale prices.

It also is important to document the use of these drugs to prove the waste was justified. The important thing to remember here is documentation. You must document the waste on the patient flow sheet. For example, the flow sheet should indicate that 30 mg was given and 10 mg was waste.

Editors Note: The answer to this issues coding question was provided by Nancy Reynolds, business manager at Baptist Regional Cancer Institute in Jacksonville, Fla. The Red Book is published by Medical Economics in Montvale, N.J. To order a copy and monthly updates, call 800-232-7379.