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claims for discarded drug, i.e. propofol

  1. #1
    Default claims for discarded drug, i.e. propofol
    Medical Coding Books
    Does anyone know the correct way to code and bill out for discarded drugs since Medicare now says they will pay for the discarded amounts? do I make another line of claim with the same J code? What would the units and charge amount be? I know I should use the JW modifier? Is it enough to put the whole thing in the information box?
    Thanks for any help.

  2. #2
    Charleston, WV
    This is my understanding of how to bill:

    Only single-use vials are eligible for payment of discarded drugs. You may "round up" and bill one unit for any partial unit administered. I don't know the code for Propofol by heart and am too lazy to look it up so lets use an imaginary example. Let's say you have a 50mg single-use vial of Happyphen.

    The doc administers 35mg to the patient and dicards 15mg. (Impressive math skills without a calculator!) Let's say the J code for Happyphen is for 25mg. In this instance you can "round up" and bill for 2 units without a modifier.

    But what if the doc only administered 25mg or less and discarded the rest? Then you can bill for 1 unit without a modifier and 1 unit with -JW.

    I believe there asre a few MACs who have their own billing requirements (some require all discarded drugs on a separate line, some don't require the -JW modifier, some want the claim form signed in the blood of your first-born child) and I think there are some other modifiers requiered if the drugs were purchased through the CAP program (which I think has been suspended).

    To be sure, check with your Medicare carrier on their billing requirements and no matter how you bill, make sure the discarded drug amounts are WELL-DOCUMENTED. CMS started watching this closely last year because of wide-spread misuse.

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