"QUESTION #4

How do we bill Depomedrol 120mg since HCPCS codes J1020-J1040 are mg specific? Also, if injecting Depomedrol 80mg (J1040) in both knees, how should this be reported?

ANSWER

According to guidance provided by CMS for hospitals under the OPPS, hospitals now have the option to report multiple HCPCS codes for a single drug administered, or continue to bill the HCPCS code with the lowest dosage descriptor available. Therefore, your reporting options are:

·   1 unit of HCPCS code J1040, Injection, methylprednisolone acetate, 80mg, and 1 unit of HCPCS code J1030, Injection, methylprednisolone acetate, 40mg, Or

·   3 units of HCPCS code J1020, Injection, methylprednisolone acetate, 20mg, for the injection of 120mg of Depomedrol, Or

·   6 units of HCPCS code J1020, Injection, methylprednisolone acetate, 20mg, for the injection of 120mg of Depomedrol.

Report CPT code 20610, Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa), for the injection procedure performed with modifiers RT, Right, and LT, Left, where appropriate."

When I ask previously and then they published in the 3rd Quarter 2005 Coding Clinic it was (note the part that I bolded and underlined - you report per total amount of mg - not how it is packaged):

"Question 3—What is the correct way to report 30mg of Depo Medrol? There are three choices, do you report HCPCS codes J1020 x2 or J1030-52 or J1020? If you report HCPCS code J1020 that is listed by 20mg, how would you report the other 10mg?

Answer—The general rule is to bill drugs in multiples of the dosage, using the smallest J code dosage available rounded up. The coder should look at the units associated with the J code and not the units based on the way the drug is stored or stocked. Therefore, report HCPCS code J1020, Injection, methylprednisolone acetate, 20mg, with 2 units of service for the 30mg of Depo Medrol."