Wiki Billing for 60mg of Depomedrol

[amwittler]

Our office only has 40mg single use vials available for the Depomedrol. They are giving pts 60mg. What is the appropriate way to bill for the medication charge? I was going to use J1040, J1040-JW since J1040 is for 40mg and 20mg are being wasted.

 

[trarut]

Actually, if you're dispensing 80 mg (2-40 mg vials), you're giving 60 mg and wasting 20 mg. J1040 is 80 mg/billing unit. You don't report waste separately because the amount given + amount wasted is equal to the billing unit. For example, if the HCPCS unit was 10 mg, you'd bill J1040 x 6, J1040-JW x 2 for an 80 mg SDV. You also would not use JZ modifier with J1040 because you do have waste, just not separately reportable.

This is Medicare's language about that:
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. (See "Medicare Claims Processing Manual ," Chapter 17, Section 40). As an example, if one billing unit for a drug is equal to 10mg of the drug in a single-use vial, and a 7mg dose is administered to a patient resulting in 3mg remaining drug being discarded, then the 7mg dose is billed using one UOS that represents 10mg on a single line item. The single line item would be processed for payment of the total 10mg of the drug administered and discarded. Billing another unit on a separate line item with the JW modifier for the discarded 3mg of the drug is not permitted because it would result in an overpayment. Therefore, when the billing unit is equal or greater than the total actual dose and the amount discarded, the use of the JW modifier is not permitted.