Urology Coding Alert

Question: We have a consent form that patients sign ahead of procedure, which says that they are aware that once a medication is open for their treatment, it cannot be used for any other patient. Because of this, patients who sign the form know they are financially responsible for the cost of the drug. Can we use this form to bill a patient covered by Medicare and Medicaid for the 150 units of Botox that were wasted?

Vermont Subscriber

Answer: When your provider has not administered the remaining drug to any other patient and must discard it, then the Medicare program provides payment for the amount of drug discarded as well as the dose administered.

Beginning July 1, 2016, you should be appending modifier JW (Drug amount discarded/not administered to any patient) to identify unused drug from single use vials that are appropriately discarded. This modifier, billed on a separate line from the other codes, will provide payment for the amount of discarded drug.

For example, a single use vial that is labeled to contain 100 units of a drug has 95 units administered to the patient and 5 units discarded. The 95 unit dose is billed on one line with the drug code and with 95 units in the unit column, 24G. The discarded 5 units are billed on the second line with the JW modifier applied to the same drug code and with 5 units in the unit column. Both line items would be processed for payment. The JW modifier is not used on claims for CAP drugs (Competitive Acquisition Program for Part B drugs and biologicals (CAP).