Question on billing with NDC numbes

kimberagame

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CORVALLIS, OR
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I tried this under general discussion, but didn't get a response. I thought maybe this forum would work out better.

Our clinic just started adding NDC numbers to our claims about 6 months ago, so it's new to us. We have a new coder in the clinic with more experience in NDC billing, and I just need to verify something she's saying, because it goes against some pretty strong core coding principles. Our clinic has only one version of Depo Medrol, which is 80mg/ml. If half a cc is given, I would report J1030 (40 mg of methylprednisolone) with one unit, and the NDC number with 0.5 as the quantity.

But the NDC number for any 80mg/ml version of Depo Medrol is only associated with J1040 (80 mg of methylprednisoline) on the HCPCS-NDC crosswalk. So our new coder is insisting that we have to report J1040 with a unit of 1, and the NDC number with a quantity of 0.5.

Is this correct? Do we really have to report, what I consider to be, an inaccurate HCPCS code, just because of the particular product our clinic buys?

We gave 40 mg of Depo Medrol. There's a HCPCS code for 40 mg of Depo Medrol. Are we really required to use the HCPCS code for 80 mg so that our NDC code matches in the crosswalk?

Thanks for any help!
 
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