Wiki Botox Coding Question

[amywebs]

I need some help, Can someone please help me with coding Botox J0585 100 unit vials. I am working with physicians that are billing out 155 used with 45 waste with modifier JW. Ok where I am having the problem is It has been my understanding that we bill it out on three lines.
Like this:
J0585 100 JZ
J0585 55
J0585 45 JW
Ok but the billing department is saying we should be billing it like this
J0585 155
J0585 45 JW
But it was my understanding that we needed to bill each vial on its own lines not combine them. Because if you combine it then how can you clarify that there is no waste-Modifier JZ on the first vial. Because if you combine the vials then you cant put the Jz-No waste on the line because its only half right. I have looked at several LCD's and Articles with Medicare and Article A57186, states " Is supplied in 100-unit vials and is billed per unit. And my supervisor and billing is telling me they think this is what is confusing me. UGH please help. The Botox is billed with pain clinic procedures, nothing cosmetic. I would really love some actual coders view on this and help so I am coding this correctly.

Also is the J0585-100 unit Vial of Botox considered a Single use vial? There are differing opinions on this point also

 

[aimee.albuerne]

Your Billing Department is saying the correct way to bill for the services you performed in two lines like this
J0585 155 unites used
J0585 45 JW wasted

 

[amyjph]

You are getting confused because you have to look at the HCPCS description of the code J0585. The code is for 1 unit only/not vial #. You don't bill it based on the "vial", you bill it based on how much was injected. So, for example, if the provider injected 155 units (standard), they have to use two vials if your vials come in 100 unit but they cannot give the remainder of the second vial to anyone else. Think of it like this, you are billing one line for the total administered and one line for the total wasted, regardless of how many vials it took to get to that #. No JZ on the administered line since it took two vials combined to equal that 155. One of the vials had waste. They will also know because of the NDC #'s. So, you bill as suggested above:
155 total units given.
45 wasted.

HCPCS Codes
J0585 ONABOTULINUMTOXINA, 1 unit (Botox)
Botox is single use. For any drug you can confirm on the FDA labeling and can look up the NDC for 100% confirmation. Example: For Injection: 50 Units, 100 Units or 200 Units vacuum-dried powder in a single dose vial.

You are also confused because of the JZ. I understand what you are saying, you are trying to split it to account for the one full 100 vial being used by doing three lines, but that is not correct. You would not put the Jz on the first line of 155 units, only the JW on the second line of waste. See here: https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00142500
More than one vial
When more than one single-dose container is used to administer the required dose and there are discarded amounts, file claim using two detail lines.
For example, if two vials labeled as containing 50 mg are used to prepare a prescribed dose of 80 mg of a drug (assuming that each billing unit is 1 mg), the claim should be billed on two lines: the first line should include the billing and payment code, no modifier, and 80 billing units and the second line should include the billing and payment code, the JW modifier, and 20 billing units.
Drug code - JXXXX
Single-dose container - 1 mg = 1 unit
Labeled - 50 mg X 2 vials = 100
80 mg administered
20 mg discarded