Wiki Billing for Botox waste when patient requested procedure to be stopped

[mhstrauss]

Need some help with this situation please.

Patient was scheduled to come in for Botox injections for migraine, which uses 155 units of Botox. The toxin comes in 100-unit vials, so 2 vials are prepped for injection after patient arrives. Doctor starts the injection process, but patient is unable to tolerate, and the procedure is discontinued--only 50 units injected. Since we fully prepped 200 units per the migraine injection protocol, can we bill for all 200 units--we obviously could not anticipate the patient's reaction? Or only bill for 100 units, and have to eat the cost of the second hundred?

Appreciate any guidance anyone can give!!

 

[thomas7331]

The CMS/Medicare guidelines state that "the program provides payment for the amount of drug or biological discarded as well as the dose administered, up to the amount of the drug or biological as indicated on the vial or package label." I've not seen this particular circumstance addressed, but by my reading of the regulation is that the allowance would only be up to the total amount of a single-use vial. If you were to bill the waste of the second vial, it could potentially be identified as an incorrect billing since your total discarded units would exceed the amount of one vial, but you might contact your payer or carrier to see if they have any more specific guidelines on this.

 

[mhstrauss]

The CMS/Medicare guidelines state that "the program provides payment for the amount of drug or biological discarded as well as the dose administered, up to the amount of the drug or biological as indicated on the vial or package label." I've not seen this particular circumstance addressed, but by my reading of the regulation is that the allowance would only be up to the total amount of a single-use vial. If you were to bill the waste of the second vial, it could potentially be identified as an incorrect billing since your total discarded units would exceed the amount of one vial, but you might contact your payer or carrier to see if they have any more specific guidelines on this.

This was my initial thought also. Thanks for your input Thomas!