JW or Not???

[susanlrice]

If billing for an injectable where the entire vial is injected into a bag of solution--but the entire bag is not infused (dependent upon dosage ordered)--would you bill for any wastage for the drug HCPCs or only the JZ for whole vial used?

 

[CBLENNIE]

I looked at the Medicare FAQs document titled Discarded Drugs and Biologicals-JW Modifier and JZ Modifier Policy (linked here) and there is no mention of drugs that are administered via infusion at all.

However, the Medicare Claims Processing Manual Chapter 17-Drugs and Biologicals section 40 Discarded Drugs and Biologicals (linked here) makes an interesting statement that seems to define what is considered a discarded amount is:

My question to you is, why was the full vial injected into the bag and then the entire bag was not infused? Did the patient have a reaction of something that required discontinuation of the infusion? Or does your facility/office/clinic always inject the entire contents of a single use vial into the IV bag, and they only actually infuse the prescribed dose?

If it is the first scenario where the prescribed dose was the full vial and the infusion was discontinued for some reason, it appears to me that it does not meet the criteria of a discarded amount.

However, for the second scenario I mentioned if your process is to just inject the entire vial into the IV bag even though it is more than what is prescribed to the patient and the infusion is stopped once the prescribed amount has been infused leaving some of drug remaining in the IV bag it appears to meet the criteria of a discarded amount.

The there is nothing that I could find that specifically mentions a situation where an entire vial is injected into an IV bag and then the entire bag is not infused into the patient. I think you have to consider which of the two scenarios above apply in order to answer your question. It seems to me it is all about the intent behind injecting the entire vial into the IV bag and why the entire bag was not infused.

If anyone out there as documentation about this situation that specifically speaks to the OPs question that contradicts what my interpretation of the information in the documentation, I cited from Medicare I would love to see it. I can't say my interpretation is correct, it is just what I came up with based on my understanding of the manual. I'm open to being incorrect in my reading of the manual.