Discarded Drugs and Biologicals

by  Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
March 7th, 2016

When a portion of a drug must be discarded, Medicare allows payment for amount administered as  well as the discarded portion. Your Medicare carrier may require you to use modifier JW. The JW modifier is to be applied only to the portion discarded. Multi-use vials are not subject to payment for discarded amounts.

Take a look at some examples from the AMA:

Question 1:

Can you round up to the nearest whole number when 2 mg of a drug is administered, and the code descriptor specifies up to 10 mg?

Answer:

Yes. For example, HCPCS code J2270Injection, morphine sulfate, up to 10 mg, would be reported as 1 unit for the number of milligrams administered up to 10. If 2 mg were administered, report HCPCS code J2270 one (1) time.

HCPCS code J9265Injection, paclitaxel, 30 mg, should be reported four (4) times if 100 mg were administered.

Please note, units of drugs should be reported based on the way the drug is administered to the patient, not on the way it is packaged, stored or stocked. When the drug dosage amount provided to the patient is greater than the amount indicated for the drug HCPCS code, the reported units should be rounded up. When the drug dosage amount is less than the amount indicated for the drug HCPCS code, use 1 as the unit of measure.

Question 2:

Our doctors inject patients with Kenalog, J3301, Injection, triamcinolone acetonide, not otherwise specified, 10 mg, and other steroid injections. If a patient is injected bilaterally in the knee, hip, or shoulder, do we report the J code as unilateral or as a unit of 2?

Answer:

The HCPCS J-code would be reported for the drug/substance administered. For example, a 40 mg/ml injection of Kenalog being administered, report J3301, "Injection, triamcinolone acetonide, not otherwise specified, 10 mg", x four (4) units. The appropriate code from CPT code range 2060020610 (joint injection) would be reported for the injection administration/procedure. 

Question 3:

How do you report units of a “Not Otherwise Classified” drug?

Answer:

When reporting a “Not Otherwise Classified” or “NOC” drug, such as HCPCS code J3490, Unclassified drugs, or J8499Prescription drug oral, nonchemotherapeutic, NOS, the following should be indicated in either the electronic narrative or Item 19 of the CMS-1500 form:

List the number of units of service as “1.”

Hospitals should make sure that no other appropriate unlisted/NOC HCPCS code describes the drug that is reported since there are several unlisted drug HCPCS codes that exist to date.

HCPCS codeLong descriptor
C9399 Unclassified drugs or biologicals
J0220 Injection, alglucosidase alfa, 10 mg, not otherwise specified
J0256 Injection, alpha 1 proteinase inhibitor (human), not otherwise specified, 10 mg
J0833 Injection, cosyntropin, not otherwise specified, 0.25 mg
J1566 Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg
J1599 Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg
J3490 Unclassified drugs
J7192 Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified
J7199 Hemophilia clotting factor, not otherwise classified
J7599 Immunosuppressive drug, not otherwise classified
J8498 Antiemetic drug, rectal/suppository, not otherwise specified
J8499 Prescription drug, oral, non-chemotherapeutic, not otherwise specified
J8597 Antiemetic drug, oral, not otherwise specified
J8999 Prescription drug, oral, chemotherapeutic, not otherwise specified
J9020 Injection, asparaginase, not otherwise specified, 10,000 units
J9999 Not otherwise classified, antineoplastic drugs
Q2050 Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg
Q2051 Injection, zoledronic acid, not otherwise specified, 1 mg

In addition, for drugs that have multiple HCPCS codes, be sure you are using the correct code. Take a look at J0220 and J0221 for example; both describe an alglucosidase alfa drug, however, HCPCS code J0221 should only be reported for the brand name Lumizyme, while HCPCS code J0220 should be reported for all other alglucosidase alfa drugs.

Read the entire article: Reporting drugs and biologicals. AHA Coding Clinic for HCPCS. 2013; Volume 13 Issue 2

References:

Discarded Drugs and Biologicals. (2016, March 7). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/discarded-drugs-and-biologicals-31611.html

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