Calculate the Correct J0897 Units for Denosumab Injection
Question: A patient with osteoporosis presents to the physician’s office for a scheduled injection. After confirming the order and relevant laboratory results, the clinical staff administers 60 mg of physician-supplied denosumab by subcutaneous injection. The dose is taken from a single-dose prefilled syringe with no drug remains to be discarded. Which HCPCS Level II code should the practice report for the drug, how many units should it submit, and is a drug-waste modifier required? New Mexico Subscriber Answer: Report J0897 (Injection, denosumab, 1 mg) with 60 units. To calculate the units, you’ll divide 60 mg (the dosage administered) by 1 mg (value of the descriptor), coming to 60 units. According to the code descriptor, J0897 describes the drug supply and does not include the work of administering the subcutaneous injection. When documentation supports the service of administering the drug and payer requirements are met, report the injection code separately. As the entire contents of the single-dose prefilled syringe were administered without any drug discarded, you should append modifier JZ (Zero drug amount discarded/not administered to any patient) to the J0897 claim line when reporting the service under Medicare’s discarded-drug policy if the patient is a Medicare beneficiary. The Centers for Medicare & Medicaid Services (CMS) requires providers to report either modifier JW (Drug amount discarded/not administered to any patient) for discarded amounts or modifier JZ when no amount from an applicable single-dose container is discarded. In situations where there is drug left over and discarded, the amount should be recorded in the documentation. CMS explains the modifier JW/JZ reporting requirements in the Medicare Claims Processing Manual, Chapter 17, Section 40, and in MLN Matters® MM13056. If the patient doesn’t have Medicare coverage, check their respective payer’s policies. Rachel Dorrell, MA, MS, CPC-A, CPPM, Production Editor, AAPC
