waste on solumedrol

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4
Location
Denver, CO
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I have a quick question for you I am pretty new to coding and I can’t figure this one out at all. I have a patient that gets her Rituxan infusions here and she was premedicated with Solumedrol which comes in 125mg. We only gave the patient 62.5mg and we wasted the other 62.5mg. The reason for the waste is the patient stated that it makes her very hyper and she has a hard time sleeping at night. The patient already takes Benadryl for her premedication and she stated that the 125mg of solumedrol is to much for her. She has BCBS Pera Medicare I know that the waste will more than likely get denied but I still have to bill this out. But I have no idea on what diagnosis code to tie the waste to since she didn’t have a adverse reaction. I am so lost on this one and your help would be greatly appreciated. Can someone guide me please and thank you for your help.



Thank you so much
 

trarut

True Blue
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649
Location
Columbus, OH
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If you're dispensing as ordered, there's no need to document separately.
If you did a one-time dose reduction on an order for 125 mg, a note in the medication administration record as to why the reduction was done should suffice. Our pharmacists enter a clinical pharmacy note to document that kind of thing but before we had pharmacists, our dispensing nurses just noted in the MAR.

I presume you'll be reporting J2930 for up to 125 mg. No need to report waste separately since the 125 mg is equal to 1 billing unit. Just bill your J2930 x 1 and make sure the documentation supports what was given. I don't think you'll have a problem.
 
Messages
4
Location
Denver, CO
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So if i bill out the 125mg the insurance will pay the whole thing and we only gave her half of that. The documentation supports and explains that we gave her half and wasted the rest. The insurance should only pay for what the patient received correct? This is so confusing sorry
 

SharonCollachi

True Blue
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2,146
Location
Clovis, CA
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So if i bill out the 125mg the insurance will pay the whole thing and we only gave her half of that. The documentation supports and explains that we gave her half and wasted the rest. The insurance should only pay for what the patient received correct? This is so confusing sorry
No. One unit of solumedrol is UP TO 125mg. There are many drugs that are billed that may not be the full amount.
 

trarut

True Blue
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649
Location
Columbus, OH
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You're using a 125 mg single-dose vial - because it's single-dose, you should be paid for the content of the vial, not just the dispensed dose. It's expected there will be waste if the patient receives less than 125 mg. Once the vial is punctured, any remainder in the vial can't be used for another patient. Payers know this which is why we do get paid for waste on single-dose vials.

Waste can be complicated and I could provide many other examples but I'll refrain ;)
 
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