Wiki Botox Injections and Waste (Remaining given to another provider)

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candyjl78

candyjl78

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I have a scenario where one provider gives the patient a Botox injection for a migraine and they want to give the remaining Botox to another physician in another clinic (but through the same hospital) to use for neuropathic pain on the same patient. The patient's insurance will pay for Botox for migraines, but not Botox for neuropathic pain. My understanding is the provider wants to find a way to reduce costs to the patient because they will have to pay for the injection for neuropathic pain out of their own pocket yet still get paid for the Botox units.

Is the first provider allowed to bill for the injection plus Botox x #units and use the JW modifier for waste if they are giving the remaining Botox to another provider for use on the same patient? I have researched and I'm really struggling with an answer for this one. I would think the first provider can't bill JW modifier because they are not "throwing out" the remaining Botox. Also, how would the second provider bill? They can't then bill JW if they are receiving the Botox from another provider, can they?

I appreciate any help on this because this is NOT my area of expertise AT ALL!
 
Modifier JW is defined as "Drug/Biological Amount Discarded/Not Administered To Any Patient" so if the remaining drug can be administered to the patient by another provider, at another encounter, or to another patient, then this modifier would absolutely not be appropriate. The modifier is intended only for reporting discarded amounts of a drug packaged in a single-use vial that must be wasted, so that providers can receive appropriate payment for the use of the full vial. It would be incorrect to use this in the situation you describe above.
 
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The other question should be, is it appropriate for the other provider to bill the insurance for the administration of a medication that is not covered?
 
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