Orthopedic Coding Alert

Question: One of our patients had an allergic reaction to a drug, causing us to waste nearly the entire vial. How should we code this?


Virginia Subscriber


Answer: When you have to discard part of a drug, document the amount the surgeon administered and the amount wasted. Your payer may have specific requirements, like Trailblazer's instruction to append modifier JW (Drug amount discarded/not administered to any patient) to the code for the wasted portion.

If you can't avoid discarding a portion of a single-use vial, Medicare will cover the amount of the drug you discarded along with the drug administered, according to the Medicare Claims Processing Manual, Chapter 17, Section 40 (www.cms.hhs.gov/manuals/104_claims/clm104c17.pdf).

Example: You plan to administer 40 units of a drug, but you must stop administration after three units because of the patient's reaction. You should code the drug and report 40 units.

Another way: Some carriers, like Trailblazer, instead prefer you to report the drug you administered on one line with three units (the amount administered in the example) and on another line report a code for the wasted drug with modifier JW and the remaining 37 units. If you can't divide the units of the drug, code the drug once with the full number of units and append JW to indicate that you discarded a portion.

Note: If the surgeon halts the shot due to patient reaction, your payer may prefer you to include an add-itional diagnosis code such as V64.1 (Surgical or other procedure not carried out because of contraindication) or E932.0 (Adverse effect, adrenal cortical steroids).