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holnkevin

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Our pain office has just started using drug waste, how do you bill for this, I know it has to go with units used and units wasted but the office has no clue what the units are just the mg. the code they are using is J1885 Ketorolac 60 mg (they used 30mg, wasted 30 mg). How does this get billed if it needs to go as units?
 
holnkevin said:
Our pain office has just started using drug waste, how do you bill for this, I know it has to go with units used and units wasted but the office has no clue what the units are just the mg. the code they are using is J1885 Ketorolac 60 mg (they used 30mg, wasted 30 mg). How does this get billed if it needs to go as units?
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If the dose given is less than one unit, you bill for one unit and do not use the modifier.

Link to Medicare Claims Processing Manual - the part I pasted below is on page 22:


The JW modifier is only applied to the amount of drug or biological that is discarded. A situation in which the JW modifier is not permitted is when the actual dose of the drug or biological administered is less than the billing unit. For example, one billing unit for a drug is equal to 10mg of the drug in a single use vial. A 7mg dose is administered to a patient while 3mg of the remaining drug is discarded. The 7mg dose is billed using one billing unit that represents 10mg on a single line item. The single line item of 1 unit would be processed for payment of the total 10mg of drug administered and discarded. Billing another unit on a separate line item with the JW modifier for the discarded 3mg of drug is not permitted because it would result in overpayment. Therefore, when the billing unit is equal to or greater than the total actual dose and the amount discarded, the use of the JW modifier is not permitted.
 
what we cant figure out is what is one unit of this drug, is it the same as one quantity or how do you figure units of a drug, its 60 mg and 30 mg was used and 30 mg wasted
 
 
holnkevin said:
what we cant figure out is what is one unit of this drug, is it the same as one quantity or how do you figure units of a drug, its 60 mg and 30 mg was used and 30 mg wasted
Click to expand...

Oh sorry - I misread your post. I read it as you knew what one unit of J1885 was, and you weren't sure how to bill when the amount given/wasted was less than one unit. (I didn't look up the J code because I didn't have my encoder open or a book handy.)

As Amy said, you'd look up the description and definition of the J code in the HCPCs book. It will tell you what one unit of that drug represents for billing purposes, and then you have to do the math to determine how many units were given.

Pay special attention to the unit of measurement. J1885 is measured in milligrams, so you're fine in this case. However, some drugs in the HCPC book have units in MCG (micrograms), so if you're billing for one of those you'd have to convert milligrams to micrograms to get the correct number of units. Otherwise, you could end up with some huge billing discrepancies!

(Ex - If the unit was 5 mcg and the dose was 5 mg, you'd bill 5,000 units. You'd have a big discrepancy if you saw the 5 mg and billed for 1 unit without converting to micrograms.)

J1885
Injection, ketorolac tromethamine, per 15 mg
 
Side note - depending on the EMR/EHR most have J code/drug/NDC libraries where this can all be loaded. Depending on radio buttons, templates or other options chosen while documenting, it should be able to automatically convert/add up according to the dosage given. It's always good to double check but this should be automated.
 
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