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Thread: claims for discarded drug, i.e. propofol

  1. #1

    Default claims for discarded drug, i.e. propofol

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    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
    Join Date
    Apr 2007
    Location
    Charleston, WV
    Posts
    244

    Default

    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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