Author Topic: How to classify NDC under HCPCS.  (Read 146 times)

o.salas

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How to classify NDC under HCPCS.
« on: March 26, 2021, 10:20:21 PM »
I'm a software developer. I'm researching about parameters to classify NDC under HCPCS. I started with the HCPCS/NDC crosswalk published by medicare but it's too short in practice. For example if searching for 59746-0173-06, it doesn't appear in any crosswalk, but this is predniSONE PO TABS 10 MG, so we can classify this as J7512. In my research i can se.

An NDC can be under multiples HCPCS
Presentation of the same drug (gammagard) can be under distinct HCPCS (This is the complicated case).

My steps to classify (wrong) is simple.
Check the dosage of the HCPCS and divide the strength of the "equivalent drug" to get MC-Units after assign HCPCS.

Michele

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Re: How to classify NDC under HCPCS.
« Reply #1 on: March 27, 2021, 11:54:05 AM »
I'm sorry, but I am not sure what the question is. 
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o.salas

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Re: How to classify NDC under HCPCS.
« Reply #2 on: March 27, 2021, 07:20:38 PM »
Given an NDC and the list of all HCPCS from cms.gov, how to classify this NDC under a HCPCS

Example:

59746-0173-06 - J7512

RichardP

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Re: How to classify NDC under HCPCS.
« Reply #3 on: March 27, 2021, 07:44:13 PM »
o.salas - you say that you are a software developer.  Are you trying to develop the logic for If > Then statements in a software program, or something similar?  If the answer is "Yes", then you are asking your questions in the wrong place.

I assume you are asking a software program If > Then type of logic question.  The kinds of statements you are making do not come up in our billing routines.

If we need to include an NDC in our billing, the NDC comes from the manufacturer of the product in view.  Usually the NDC is included on the packaging of the product.  Or, we simply Google the product name + NDC Number and it pops up in the search results.

I don't have time to research this, but I know there are web links to various IT folks / departments who are involved in creating the data sets and rules for the same for CMS.  In particular, there is a technology office whose name I cannot remember at the moment, so I have nothing with which to google for their website.  This link might give you some information that you can use to start researching on your own.  If you already know about this page, then nevermind.

https://www2a.cdc.gov/vaccines/iis/iisstandards/vaccines.asp?rpt=ndc


RichardP

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Re: How to classify NDC under HCPCS.
« Reply #4 on: March 27, 2021, 07:57:33 PM »
o.salas - you make reference to NDC numbers appearing in more than one location; e.g. An NDC can be under multiples HCPCS

Yes.  And, also - since there can be Unit of Use and Unit of Sale NDCs for one product, it is important to know which type of NDC you are looking at or looking for.

Then there is this, at the bottom of this link:
https://www.dummies.com/careers/medical-careers/medical-billing-coding/medicare-lcds-and-ncds-in-medical-coding-and-billing/

For example, SERVICE 12345 may be covered in Region A to treat diagnosis ABC. But the same service may be covered in Region B only to treat diagnosis XYZ. So when an item or service is in question, always check beforehand. If a Medicare beneficiary receives an item or service that is not a covered benefit and has not signed an ABN, the provider usually has to absorb the cost

If you are writing software code, your If > Then logic statements are going to differ, depending on which Medicare Region you are coding for.

o.salas

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Re: How to classify NDC under HCPCS.
« Reply #5 on: March 28, 2021, 12:02:09 AM »
Hi all. First, thanks for your answers. I already know all the topics you are talking about. My issue building software is that not all approved NDC on the FDA have assigned HCPCS on any crosswalk. For example the NDC i mention above doesn't appear in any CMS crosswalk from 2005 to current quarter, so someone based on some knowledge can classify that NDC under the J7512. Those steps to classify an NDC under HCPCS is what i'm talking about.

Michele

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Re: How to classify NDC under HCPCS.
« Reply #6 on: March 29, 2021, 10:43:55 AM »
This is definitely not something that comes up in our billing process.  Like Richard said, we get the billing and the NDC numbers either come from the manufacturer or we google it.  In the billing we do the NDCs we need are mostly commonly used medications.  Sorry I can't be of more help!
 :-\
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