Oncology & Hematology Coding Alert

If drug waste occurs because your provider did not evaluate the patient sufficiently prior to drug preparation, you probably won't be able to bill for the unused drug portions.

Most chemotherapy drugs require preparation such as mixing (this may mean reconstituting a single drug or mixing several drugs in the same bag). Each patient requires a unique chemo cocktail.

If the patient reacts badly to the drugs after administration has begun, the provider may have to discontinue the infusion. Because the drugs are prepared based on the patient's total skin surface and body weight and there is only a partial dose remaining, the drugs cannot be used for any other patient. In such a case, you can report the drug wastage.

However, if the provider prepares the drugs and then, prior to beginning the infusion, determines that the patient is not able to receive any chemotherapy, you cannot bill for the wasted drugs. An appropriate evaluation to be sure that the patient was fit for the service (before mixing the drugs) could have prevented the drug waste.

Unless you receive written instructions to the contrary, your payer won't reimburse your drug costs for such a mistake.

Additionally, if the provider "slips up" when preparing a medication and gets the mix wrong, Medicare won't pay, Acevedo notes.