Should Report Wastage On Toxin Injection

By Author: James Smith
Total Articles: 3
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Question: My neurologist scheduled two patients back-to-back for b otulinum type B injections. However he did not use all of the Botox and we disposed it. Do I require to report the wastage when my neurologist does not use the whole amount of botulinum toxin? If it's the case, how do I report the wastage?


Answer: Yes, you can typically bill for botulinum toxin waste.


If you split the vials between patients, bill for the exact units provided per patient. If your provider has some leftover, you should bill for the total number of units used. After that, you document the number of units that had to be wasted or discarded on the final patient.


In this example, you might go for 64613 (Chemodenervation of muscle[s]; neck muscle[s] [e.g., for spasmodic torticollis, spasmodic dysphonia]) for one procedure, and report 64614 (...extremity[s] and/or trunk muscle[s] [e.g., for dystonia, cerebral palsy, multiple sclerosis]) for the other.


Say your doctor has botulinum ...
... type B (10,000 units) on hand for the procedures and administers the drug as here:


Patient A gets 4,000 units of botulinum B
Patient B gets 4,000 units of botulinum B with 2,000 units of unavoidable wastage.


Go for 40 units of J0587 (Injection, rimabotulinumtoxinB,100 units) for patient A and 60 units of J0587 for patient B - 40 for the injection plus 20 for the wastage.


Keep a watch: There are some payers that require the wastage to be reported on a separate line item with the modifier JW (Drug amount discarded/not administered to any patient) appended. For the payers that need the separation, you should report 40 unit of J0587 on one line item and the wasted 20 units of J0587-JW on a second line item for this instance.


Your provider's documentation needs to demonstrate the exact dosage of the drug injected and the exact amount and reason for the unavoidable wastage. You may also have to follow some payer instructions to get reimbursement.


Bottom line: Check with your payers to know their specific policy on coding wasted drugs.


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