Wiki Billing for Waste

[chenson384]

I need to find verification that you DO bill for waste on injectibles. Am I overlooking this info in the HCPCS book?

Example: Single dose vial of 80mg, depo, shelf life 24 hours, Provider orders 40mg and that is administered, yet the additional 40 mg in the SDV is waste. Our clinic director is telling us this would be a loss and not billable. I have always been told it is billable if there is no option to use the medicine.

 

[chenson384]

Thanks to my wonderful CPC co-worker, I have this answer. While I was in the discussion forum she went out on the AAPC website and found just what we need.

We did not know about the JW modifier that we must use to designate the amount of waste, so we also learned something new.

For interested coders: Bill the injectible with correct dosage given and on second line bill the waste with JW modifier for the units wasted. The amount administered and the amount wasted must be billed on seperate lines, but on the same claim.

 

[duncheart]

I'm curious if the provider ordered 40 mg of depo (Medrol, I assume), why wasn't the 40 mg vial used, J1030?
I have attached a link to a recent CMS/Highmark presentation about Billing Medications that should help you make some decisions about drug waste. As always, you may want to also talk to your Medicare contractor for advice that may be helpful in your geographic location.
Good luck.

https://www.highmarkmedicareservices.com/calendar/parta/teleconferences.html

 

[ollielooya]

Yes, our provider bills for the wastage of botox It doesn't need to be a write off, as this can be quite costly. We do use the JW modifier as well and as long as this is documented in the chart notes, should not have a problem in reimbursement. The responses you're receiving have been good ones.

---Suzanne E. Byrum