Wiki Drug waste & -JW mod

[MYAEKEL]

If a physician injects 6 units of a 100 unit single use Botox vial for Clonic hemifacial spasm, does 94 units have to be reported as waste with the modifier JW? Do all insurances pay the waste?
Thanks in advance!

 

[trarut]

If it's a single-dose vial, yes the waste is reportable with a modifier JW. The payers have been cracking down on drug waste the last couple of years so how much of that you get paid will depend on whether the medication is available in a smaller size vial. Providers are expected to purchase vials that will result in the minimum amount of waste. For example, if the medication is available in 25 mg, 50 mg and 100 mg vials, the payer will likely only pay 19 mg waste and you will have to write off the other 75 mg. (Been down this road many times and have audited way too many pharmacy records for our AR team for this very reason.)

 

[trarut]

Agree with trarut. JW Modifier can only be used for wastage on a "single use vial" after administering a dose/quantity to the patient. You'll want to bill as:
HCPCS J code x 6 units
HCPCPS J code-JW x 94 units for discarded amount.
Use only when you cannot use the rest of the vial on another patient. I've had providers ask if we could bill JW modifier when the staff has accidentally dropped the vial and it broke and we were unable to use it. Nice try but not meant for that type of scenario.

The description says discard, not clumsy

 

[MYAEKEL]

If it's a single-dose vial, yes the waste is reportable with a modifier JW. The payers have been cracking down on drug waste the last couple of years so how much of that you get paid will depend on whether the medication is available in a smaller size vial. Providers are expected to purchase vials that will result in the minimum amount of waste. For example, if the medication is available in 25 mg, 50 mg and 100 mg vials, the payer will likely only pay 19 mg waste and you will have to write off the other 75 mg. (Been down this road many times and have audited way too many pharmacy records for our AR team for this very reason.)

Thanks for your response Botox only comes in 1 vial size so there is no smaller size we can get to reduce waste. Somewhat additional question, it's our understanding that single use vials can only be used on one patient is that correct?

 

[MYAEKEL]

Agree with trarut. JW Modifier can only be used for wastage on a "single use vial" after administering a dose/quantity to the patient. You'll want to bill as:
HCPCS J code x 6 units
HCPCPS J code-JW x 94 units for discarded amount.
Use only when you cannot use the rest of the vial on another patient. I've had providers ask if we could bill JW modifier when the staff has accidentally dropped the vial and it broke and we were unable to use it. Nice try but not meant for that type of scenario.

Thanks for your response It's our understanding that single use vials can only be used on one patient is that correct?

 

[trarut]

Yes, that's also my understanding.
With Botox coming in only 1 vial size, you should avoid the issue I described (thank goodness!) The payer may question the large amount of waste if it's not a normal dose/waste ratio but a copy of the order and dispense record should take care of that, along with the package insert to show it's only available in the one vial size.

Good luck

 

[CBLENNIE]

You might want to double check on the vial sizes available for Botox as per the FDA labeling it comes in 3 sizes, 50 units, 100 units & 200 units. Here is a copy of the FDA labeling insert. https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/103000s5236lbl.pdf. I work for an insurance company and we frequently deny claims for excessive waste for not using the smallest vial size available and have excessive waste as a result.

 

[trarut]

You might want to double check on the vial sizes available for Botox as per the FDA labeling it comes in 3 sizes, 50 units, 100 units & 200 units. Here is a copy of the FDA labeling insert. https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/103000s5236lbl.pdf. I work for an insurance company and we frequently deny claims for excessive waste for not using the smallest vial size available and have excessive waste as a result.

Great advice! I didn't check personally before answering above but I know we have some medications we use that are single use, one size so it's not uncommon.

OP - Most of the big payers have drug waste policies available and reviewing those will help you. I also suggest sharing this information about the payer rules with drug waste with whomever handles your purchasing. I know it helped our pharmacy team better understand what was going on and they adjusted their purchasing accordingly.

 

[MYAEKEL]

You might want to double check on the vial sizes available for Botox as per the FDA labeling it comes in 3 sizes, 50 units, 100 units & 200 units. Here is a copy of the FDA labeling insert. https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/103000s5236lbl.pdf. I work for an insurance company and we frequently deny claims for excessive waste for not using the smallest vial size available and have excessive waste as a result.

Just looked into this, my understanding is that the 50 vial size is NOT available in the US but is in Europe

 

[CBLENNIE]

The FDA labeling link I sent is the current and up to date information on the vial sizes available for Botox and the FDA would not include the 50 unit vial information it if wasn't available in the US. I would talk to your supplier to verify what your purchasing options are because if the 50 unit vial is available and the insurer limits you to the smallest vial size you are potentially going to be out the reimbursement of 50 units due to wasting of 94 units, meaning they will only reimburse you for 44 units of drug waste. If this is a one time deal it may be a bit of a financial hit but if this is a regular occurrence this is likely going to be a pricey issue for your practice.

Also, did you have to prior authorize the treatment for this patient? If so I would check to see if the authorization mentions how many units total are authorized including drug wastage. When my company issues a prior authorization for a drug that only comes in a single use vial the authorization will specify how many units are authorized total including any drug waste.

 

[MYAEKEL]

The FDA labeling link I sent is the current and up to date information on the vial sizes available for Botox and the FDA would not include the 50 unit vial information it if wasn't available in the US. I would talk to your supplier to verify what your purchasing options are because if the 50 unit vial is available and the insurer limits you to the smallest vial size you are potentially going to be out the reimbursement of 50 units due to wasting of 94 units, meaning they will only reimburse you for 44 units of drug waste. If this is a one time deal it may be a bit of a financial hit but if this is a regular occurrence this is likely going to be a pricey issue for your practice.

Also, did you have to prior authorize the treatment for this patient? If so I would check to see if the authorization mentions how many units total are authorized including drug wastage. When my company issues a prior authorization for a drug that only comes in a single use vial the authorization will specify how many units are authorized total including any drug waste.

Please let me know where you can purchase a 50 unit vial for MEDICAL use in the U.S. To my knowledge only COSMETIC Botox is available in a 50 unit vial.