Neurology & Pain Management Coding Alert

Question: How should I bill for the unused amount of Botox as wastage?


Maryland Subscriber


Answer: Many payers want you to include the unavoidable wastage in the total amount of units for the single line item. For example, the neurologist injected 9,000 units of Myobloc with 1,000 units of unavoidable wastage (that he documented in the note). You would bill this as J0587 (Botulinum toxin type B, per 100 units) x 100 units. This is a single line item.

Medicare carrier TrailBlazer has the following in its  LCD for drug wastage:

Trailblazer, a Medicare carrier in Maryland, recommends that your documentation clearly shows any amount wasted as well as the time and reason for the wastage. You should use modifier JW (Drug amount discarded/not administered to any patient) to indicate the drug amount discarded/not administered to any patient. You should show the amount administered on a separate detail line from the amount wasted, indicated with the modifier JW (when applicable). You should not use modifier JW for claims billing when the drug code description already includes the amount administered along with the amount wasted.
 
So Trailblazer requests two line items. For our example above, you should code the Botox to TrailBlazer as:

- J0587 x 90 units
- J0587-JW x 10 units. Best bet: Ask payers for their policy on how they want wasted drugs reported.