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Teresa Posted 2 Year(s) ago

If a patient comes in for chemo. (example OPDIVO) and the drug is mixed, but not given because when the nurse was preparing to administer the drug the patient doubles over grabbing his/her chest and is then taken to the hospital via an ambulance. The drug is held at the clinic since it is good for 24 hours once mixed; however the patient is admitted to the hospital so the drug is disposed of and therefore not given. Can we bill for this and if how is this coded?

SuperCoder Posted 2 Year(s) ago

This is a unique case. You cannot bill for the Injection/Infusion services. But you can bill for appropriate Office visit E&M and the drug.
For E&M, mention the reason of visit, and the reason, why the medication was not given. For Drug, use Modifier -JW (Drug amount discarded/not administered to any patient) with the appropriate HCPCS code. Also, provide the medical records to your insurance, which clearly indicates the reason of drug discard.

Teresa Posted 2 Year(s) ago

Can you give me a resource site or reference for this. I have asked around at my office and they do not believe that the drug can be billed for.
Thanks

SuperCoder Posted 2 Year(s) ago

Check the link: http://www.wpsmedicare.com/j5macparta/resources/modifiers/modifier-jw.shtml and https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM7095.pdf

Teresa Posted 2 Year(s) ago

I reviewd the sites that you suggested, but I am concerned that the sites are referring to at least a portion of the drug being administered, but in the scenario that I sent for review, the drug was never administered. So are you saying it is okay to bill the whole amount of the drug as waste?

SuperCoder Posted 2 Year(s) ago

After digging down more, we found that JW can only be billed for discarded or not administered drug when some of the drug was administered on the same day. So, yes, you cannot report this case with -JW modifier. Also, you cannot bill for the drug or biological if none has been administered to the patient. Read the question-answer in the link mentioned below. https://www.supercoder.com/coding-newsletters/my-oncology-hematology-coding-alert/reader-question-do-not-bill-for-wastage-when-drug-not-administered-139966-article

Teresa Posted 2 Year(s) ago

Thanks for the reference, but ufortunately I do not have authorized to view the link.

SuperCoder Posted 2 Year(s) ago

Not an issue. Please find below the content from the link.

"Question: If a patient has an intraperitoneal saline drip started and carbo was to be put into the drip but the port was nonfunctioning, can we bill for the carbo? The carbo was pulled from the pharmacy and ready to be administered. The port malfunction was noticed while the saline was being administered before the carbo was started. Please advise if we can charge for saline and administration of saline only with no carbo charges.

Supercoder.com Subscriber

Answer: You cannot bill for the drug or biological if none has been administered to the patient. This seems to be case for the carboplatin described by you. As none of it was administered, you will bill only for the saline.

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The rule: According to Medicare, you can bill for the amount of drug discarded as well as the dose administered, up to the amount of the drug indicated on the vial or package label when the physician or provider discards the remaining drug in a single use vial or other single use package.

Before you bill for a discarded drug, you should make sure you have documentation in support of the following:

The drug or biological was supplied in a single use vial or package
The amount of drug or biological ordered and administered
Condition for which the drug or was indicated in the physician’s order
The amount of drug or biological that is wasted

You also wouldn’t report a wasted amount if the portion of a single dose vial was administered to another patient.

Check for JW modifier: For SDV vial drugs, you may append modifier JW (Drug amount discarded/not administered to any patient) to indicate some of the drug or biological was discarded or not administered to the patient.

Check your payer’s preferences for use of JW. For instance, they may ask that you report the drug amount administered on one line, and on a separate line, report the amount of drug NOT administered or wasted, with modifier JW appended to the relevant HCPCS code. Or the payor may require you to report the total amount on a single line with a modifier JW — but this is now much less common."

Posted by Teresa, 2 Year(s). There are 8 posts. The latest reply is from SuperCoder.

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