Coding for Waste in a Unique Scenario

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The rules for coding for waste are clearly documented. You can charge up to the SDV if the waste is documented and actually wasted.

I'm not able to find standards for coding if a drug is used for multiple patients in batch processing under the hood.

For instance: Drug X comes in a 500mg single dose vial. HCPCS description says 100mg/unit or 5 units per SDV. Say you batch process two IV's under the hood with a single entry into an SDV. Common practice in high volume hospital pharmacy IV rooms.

But say the POS is an office setting: Pt. #1 gets 150mg, Pt. #2 gets 250mg. Waste is 100mg. (150+250+100=500mg or 5 units) I can see Pt. #2 could be billed for 4 units.

But does Pt. #1 get billed for 2 units, 1 unit, or 1.5 units? Then does Pt. #2 get billed for 4 units or 3.5 units? If you round the 150mg to 2 units and the 250mg+100mg waste to 4 units, you just billed 6 units for a vial that only contains 5 units.

The 837p SV104 segment allows decimal places. 837P version 5010:Field allows a decimal point in SV104.The field length of eight digits does not include the decimal point. If a decimal is used, the maximum number of digits allowed to the right of the decimal is three. Source: Sample.pdf