Wiki Billing Depo-Medrol with NDC info

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kimberagame

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Hello everyone,

I'm struggling with something, and was hoping to get everyone's input. The providers at my clinic have started using a lot of Depo-Medrol for injections. Our clinic has the 80mg/ml version, but the providers always use less than 1 ml. Typically 0.5ml, so 40mg. The HCPCS code for 40mg would be J1030, but my understanding is that because the NDC number we'll report is linked to the 80 mg dose, and the NDC and HCPCS have to match, we're required to report J1040, the 80mg code. This makes me uncomfortable.

Does anyone else do this? If so, do you have a good source to back up doing it? There are sources that say they must match, but no one addressing how that could require you to use an inaccurate HCPCS code. If what we're doing is not correct, I would love to know that, too.

Thanks for any insight!
 
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you cannot report and bill for something that was not performed or a substance not provided. Therefore you will need to have the software geeks load in the correct NDC number.
 
The NDC information is only to identify the product - your HCPCS and units on the claim will report the amount that was actually administered to the patient. The HCPCS must be a valid code to correctly represent the product that was given, but the volume of the vial does not have to match the dosage represented by the HCPCS code and units - these are two different pieces of information. In other words in your example above, as long as the 80 mg/ml product is a multi-dose vial, then HCPCS codes J1020, J1030 or J1040 would all be valid for use with that NDC number since those doses could all be drawn from that same vial.
 
multiple units of Depo Medrol J1030

Could you help me understand when it would be appropriate to bill more than one unit of 40 mg Depo Medrol? We have 10ml multi use vials. After reading these posts, I am now very confused if 1ml = 1 unit or not? or if it goes by strength regardless of many ML are injected in that area?

In the first example, MD is advising to bill 6 units of J1030. In the second, 2 units of J1030.

1. Trigger point injection: Two points of maximum tenderness along her cervical paraspinal musculature were identified. The skin was prepped with alcohol and cold spray. Then, using 40 mg of Depo-Medrol and 25 mg of bupivacaine for a total of 6 mL, the 2 muscle groups were then injected evenly.

2. Right knee injection: This was performed through the anterolateral portal site with 1 mL lidocaine, Marcaine, and 2 mL of 40 mg Depo-Medrol.
 
jeskla said:
Could you help me understand when it would be appropriate to bill more than one unit of 40 mg Depo Medrol? We have 10ml multi use vials. After reading these posts, I am now very confused if 1ml = 1 unit or not? or if it goes by strength regardless of many ML are injected in that area?

In the first example, MD is advising to bill 6 units of J1030. In the second, 2 units of J1030.

1. Trigger point injection: Two points of maximum tenderness along her cervical paraspinal musculature were identified. The skin was prepped with alcohol and cold spray. Then, using 40 mg of Depo-Medrol and 25 mg of bupivacaine for a total of 6 mL, the 2 muscle groups were then injected evenly.

2. Right knee injection: This was performed through the anterolateral portal site with 1 mL lidocaine, Marcaine, and 2 mL of 40 mg Depo-Medrol.
Click to expand...

The HCPCS code and units should report the amount of the actual drug that is administered. Since J1030 has a description '40 mg', then one unit of J1030 would equate to 40 mg.

The number of ml is the volume of the drug, not the dosage, and you cannot rely just on the volume to select the number of units for the code - you would need to calculate the dosage depending on the strength or concentration (you can find this information on the drug package). Depo-Medrol comes in different strengths - 20 mg/ml, 40 mg/ml and 80 mg/ml - so depending on the strength, 1 ml could equal 20, 40, or 80 mg of the drug. So, for example, if your concentration is 20 mg/ml, then 2 ml will equal 40 mg, but if your concentration is 40 mg/ml, then 1 ml = 40 mg.

I think the way your provider is documenting is making this confusing. In your first example, the provider documented giving 40 mg, so this would be J1030 x 1 unit but, if they've asked you to bill 6 units, that suggests that they gave 240 mg. So I would question if they meant to say they administered 6 ml of 40 mg/ml? In the second example, it is not clear to me what the units are because concentration is not specified. Has the provider given 2 ml of 20 mg/ml to equal 40 mg total (one unit)? Or did they give 2 ml of 40 mg/ml to equal 80 mg total (2 units)? I would recommend querying the provider or having a discussion with them because I think the documentation is ambiguous.
 
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J1030 vs J1040 help

I've got a medical record that shows 4 total injections:
LT/RT knees (20610 x 2) and also the anserine bursa in LT/RT knees (20610 x 2) and the Physician injected 45 mg of depo-medrol into EACH site (45 mg x 4 sites= 180 mg). (NDC submitted to the carrier is 00009030602 which matches J1030)

Physician billed:
20610 x 4
J1040 x 8

I think 20610 x 4 and J1030 x 4.5
Am I way off or can I truly not tell what the correct HCPCS code is?
 
My providers inject 0.5cc of Depo-Medrol 40mg/ml. They want to report/bill that as J1020x1 Methylprdnisolone actat 20mg. I have been changing it J1030 since that is the drug they reported using. But, now I'm not sure if I should be changing it.
 
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