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help - really appreciate it

  1. Default help - really appreciate it
    Medical Coding Books
    If anybody could help me with this note I would really appreciate it. Our patient is scheduled for Botox for migraines and the Dr injects 205 units. My question is do I bill 250 units since Botox only comes in 50 units in a vial and 100 units in a vial. There is 45 units of waste. How do I bill for the waste?? Does anybody know?? My collegue is telling me to bill 250 units. HCPC code is J0585a

  2. #2
    Default Check with your MAC...
    Quote Originally Posted by anggand@aol.com View Post
    If anybody could help me with this note I would really appreciate it. Our patient is scheduled for Botox for migraines and the Dr injects 205 units. My question is do I bill 250 units since Botox only comes in 50 units in a vial and 100 units in a vial. There is 45 units of waste. How do I bill for the waste?? Does anybody know?? My collegue is telling me to bill 250 units. HCPC code is J0585a
    From Trailblazer (http://www.trailblazerhealth.com/Pub...0Wastage.pdf):
    "Billing Examples Using JW Modifier
    Per-Unit Example, Multiple Patients:
    A physician schedules three Medicare patients to receive botulinum toxin type A (J0585, botulinum toxin type A, per unit) on the same day within the designated shelf life of the product. Currently, Botox┬« is available only in a 100-unit size. Once Botox┬« is reconstituted in the physician’s office, it has a shelf life of only four hours. Often, a patient receives less than a 100-unit dose. The physician administers 30 units to each patient. Your claim for these patients would indicate J0585 billed at quantity 30 (to indicate the amount administered to the patient). Billing J0585 JW is not appropriate for these patients.
    Your claim for the last patient receiving Botox┬« in those four hours is where the remaining 10 units are to be billed to Medicare. Your last patient’s claim would indicate J0585 billed at quantity 30 (to indicate the amount administered to the patient) on one detail line. The next detail line would indicate J0585 JW billed at quantity 10 (to indicate the 10 units wasted from the 100-unit vial).
    Per-Unit Example, Single Patient:
    A physician must administer 15 units of Botox┬« to a Medicare patient, and it is not practical to schedule another patient who requires Botox┬«. For example, the physician has only one patient who requires Botox┬« or when the physician sees the patient for the first time and did not know the patient’s condition.
    Your claim for this patient would indicate J0585 billed at quantity 15 (to indicate the amount administered to the patient) on one detail line. The next detail line would indicate J0585 JW billed at quantity 85 (to indicate the 85 units wasted from the 100-unit vial).
    Note in both of the above examples the entire 100 units that were an expense to the billing provider are accounted for with the combination of the drug code on one detail line and the JW wastage on the next detail line. The code description for J0585 is billed in this manner because the billing unit (HCPCS description) does not indicate an entire 100-unit vial but a breakdown by units of the vial."

    Hope that helps!
    Last edited by btadlock1; 04-04-2011 at 09:45 PM.

  3. Default This helps alot!!!
    Just trying to understand this correctly. So if its only a single patient getting 205 units of botox my claim should say
    j0585 205 units
    J0585 JW 95 units?

    And would you know if I can get paid for the 95 units of wastage?and, does this also apply for PPO plans like blue cross and delta health systems?
    Last edited by anggand@aol.com; 04-05-2011 at 10:26 PM.

  4. #4
    Default
    Quote Originally Posted by anggand@aol.com View Post
    Just trying to understand this correctly. So if its only a single patient getting 205 units of botox my claim should say
    j0585 205 units
    J0585 JW 95 units?

    And would you know if I can get paid for the 95 units of wastage?and, does this also apply for PPO plans like blue cross and delta health systems?
    Sounds like you've got it!

    You'll have to check with your payers to find out if they cover it, and if it's on your fee schedule. With Blue Cross, it probably is covered, but it could be something that varies from group to group. Here's an example pf a Blue Cross coverage policy on it:
    https://www.msbcbs.com/medpolicy/I-99-002.html

    Keep in mind, though, that each plan has its own rules, so if someone tells you that it's covered, you need to verify whether the policy applies to all of their products, or if there are limitations in some of the plans. Good luck!

  5. Default yey!!!!
    Thanks for your help!!

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