Ask Dr. Z

Definity (Q9957) comes in a single dose vial with 1.3 mL. When billed to Medicare (Palmetto GBA is MAC) in POS 11, it is being paid but for Q9957, I see a status indicator of N1. Does JW/JZ modifier policy not apply even when being billed in POS 11 since it is a single-use drug? A billing unit is per 1 mL. The entire 1.3 mL vial is drawn by the nurse and diluted with saline for a total of 10 mL. When billing Q9957, if you have 1.3 mL, shouldn’t 2 units be billed with no waste? There is confusion with the clinic. Once the full 1.3 mL is diluted with saline, they do an initial push of 2 mL to the patient. They will continue to push more if contrast wears off. They calculate 0.13 mL of Definity in every 1 mL of the diluted syringe. The provider will order 1.3 mL of Definity for a patient, but they may document that 0.26 mL was given if only 2 mL administered. This is being billed as 1 unit only of Definity and I am confused if this is correct. I don’t believe we bill only 1 unit for 0.26 mL of diluted Definity when the entire 1.3 mL vial is withdrawn.