I work with several neuro practices and ran into a situation with a third party biller in Rhode Island billing for Botox. This particular payer does not recognize the JW modifier. The provider injected 155 units for chronic migraine and discarded 45 units. I advised the billing company that they should be billing one line with J0585 at 200 units because it is a single-use vial and the JW modifier is not recognized by this plan. They are refusing to do this and continue to bill J0585 at 155 units as well as a second line with J0585 and JW modifier with 45 units. The payer pays the line for 155 units, but not the line with JW at 45 units. The biller is insisting the provider needs to write off the 45 discarded units and that they cannot bill 200 units because the appropriate way to bill is using the JW modifier (even though this is a Medicare mandate and not all commercial plans recognize JW). Theywant me to provide something in writing that shows it is appropriate to bill for a whole a single-use vial when there is wastage for a company that doesn’t recognize the JW modifier, but I am at a loss. I just want to make sure the provider is getting paid for the drug appropriately. Please help!!!!
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Tag Archives: vials
Allergy coding for vials
We are not mixing our own vials but have a company that does it for us. Does anyone know what CPT code we use to bill the insurance company so we can get reimbursed for the vials we are buying?
CPT code for one Toe Amputation submitted in two vials
Hello everyone!
We received a toe amputation in two vials – do we have to bundle these as one "Toe, nontraumatic amputation" (which it was non-traumatic) as one 88305 because they are both parts from the same toe or can they be coded as "88305" for part 1 and "88304" for part 2?
We received a toe amputation in two vials – do we have to bundle these as one "Toe, nontraumatic amputation" (which it was non-traumatic) as one 88305 because they are both parts from the same toe or can they be coded as "88305" for part 1 and "88304" for part 2?
1. Great toe, right, amputation:
– Ulcers with acute inflammation and necrosis of skin and soft tissue with underlying acute osteomyelitis.
2. Great toe, right, bone left behind, amputation:
– Bone with no significant inflammation.
– Synovium with nonspecific reactive changes including increased vascularity and villous hyperplasia.
And I have included the email to the CPT group below for more clarity – what are everyone’s thoughts on this?
"Im not sure what to do here. I understand why a 304 seems reasonable Im assuming you are sort of treating it like a colon donut from a non-tumor case that would come in its own container. I cant find any documentation to suggest this policy is applicable to toe amputations though.
Another option would be to code the 2nd part as a Bone, Biopsy/Curettings (88307). It certainly isnt fragments, exostosis or a resection (or any other category of bone that is listed).
After reading through the toe amputation section, it makes it clear that you can bill for each toe separately, regardless of how many containers they come in (assuming individually identifiable), but it doesnt address the issue of a single toe coming in multiple containers or with additional margins at all.
Anyone else have thoughts on 3 options:
88305 x 1 because it is a single toe
88305 + 88307 (toe + bone biopsy)
88305 + 88304 (toe + we are making an educated guess about appropriate code based on other organ system)"