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wasted avastin

  1. #1
    Default wasted chemo drug
    Medical Coding Books
    hello,

    i have a patient who came in for chemo ,who never received one of the drugs. the entire drug was wasted, not due to a reaction to the drug, but a physical problem that arose which caused the doctor to cancel the drug entirely. would you bill for the entire wasted drug?

    thanks!!
    Last edited by hfrauham; 12-16-2010 at 09:15 AM.

  2. #2
    Location
    Bettendorf, Iowa
    Posts
    133
    Default
    Yes. It doesn't happen often but occasionally we have patients that react or have health issues and can't receive a particular drug after it has been mixed. Usually you can't use it for anyone else or save it so you have no choice but to waste it. As long as everything is documented as to what happen, in case you need to submit it, I would go ahead and bill the wasted drug.
    Ruth Long CPC,CHONC
    relong@rccqc.com

  3. #3
    Default
    I agree with Ruth, it doesn't happen often, but drug sometimes does need to be wasted like that. Documentation is always your friend & if for any reason the insurance company wants to know why you're billing for the drug and not admin, you can back your claim up. Good luck!

  4. #4
    Lightbulb
    The correct way to bill for wasted drugs is to use modifier JW, but in this situation, I don't believe you can get paid for the wasted drug, since none was actually administered. According to Trailblazer Medicare (our local carrier):
    Billing for Drug Wastage
    HCPCS modifier JW is defined as “drug or biological amount discarded/not administered to any patient” and is used on claims to indicate drug wastage when the above measures have been taken. The JW modifier is only to be applied to the amount of drug/biological discarded.
    The amount administered and the amount wasted must be billed on the same claim. The amount administered is on a separate detail line from the amount wasted, which is indicated with the modifier JW (when applicable).
    The modifier JW would not be used for claim billings when the actual dose of the drug/biological administered is less than the billing unit established by HCPCS description.
    As a reminder, drug wastage cannot be billed if none of the drug was administered (such as a missed appointment by the patient).
    Note: The JW modifier is not used on claims for drugs or biologicals provided under the Competitive Acquisition Program (CAP). For additional discussion on this topic for drugs/biologicals in the CAP, see the Medicare Claims Processing Manual, Pub. 100-04, Chapter 17, Subsection 100.2.9.


    It's all explained here: http://www.trailblazerhealth.com/Pub...%20Wastage.pdf
    Last edited by btadlock1; 12-29-2010 at 08:10 PM.

  5. #5
    Default
    You bring up a good point Brandi about specific jurisdictions requiring specific types of coding, however, not every jurisdiciton follows the same rules. It's always best to review your carrier's LCD.
    When it comes to drug that has to be wasted, as in the scenario presented here, providers are entitled to payment for the drug that had to be discarded. Per the document you referred to, "Drug wastage must be documented in the patient’s medical record with date, time, amount
    wasted and reason for wastage. Upon review, any discrepancy between amount
    administered to the patient and amount billed will be denied as non-rendered unless the
    wastage is clearly and acceptably documented
    ." Like I said previously, documentation is your best friend.

  6. #6
    Location
    Bettendorf, Iowa
    Posts
    133
    Default
    Use of the JW modifier is at the discretion of your MAC. I would make sure you check with your local carrier before using it to avoid denial.
    Ruth Long CPC,CHONC
    relong@rccqc.com

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