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CPT for Diastat

P Posted Tue 09th of April, 2013 15:38:09 PM

Need CPT code for Diastatgiven rectally in office as urgent treatment for seizures. Have always had samples from company but now we have had to purchase the medication.

SuperCoder Answered Wed 10th of April, 2013 12:53:03 PM

As per AHA Coding Clinic 2007 vol.7 Qtr.2:

Question 5
We are aware that there is an NDC-HCPCS Crosswalk for Medicare Part B Drugs which is updated quarterly on the CMS Web site. However, some facilities are having difficulty linking the NDC number of the drug with the HCPCS Jcode. The basic concern is, if they are going to code a drug, does the NDC number on the report have to match the NDC number that they have for the drug? For example, "diastat" diazepam rectal gel, NDC # 0187-0658-20, 10 mg, does not appear under HCPCS code J3360, Injection, diazepam, up to 5 mg. What options for reporting are available for the NDC numbers that are not listed on the report?

Answer
Comments or concerns about the NDC-HCPCS codes should be sent to e-mail address:sec303asp data@cms.hhs.gov. In general, the NDC-HCPCS Crosswalk provides information on certain NDCs that should be billed for the drug code.

In the example provided, HCPCS code J3360 would not be the appropriate code to report for NDC #0187-0658-20 since this NDC is for the rectal gel version, which is inserted and not injected. HCPCS code J3360 should only be
used to report those diazepam drugs not in injectable forms.

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Office supply expenditures are calculated within the MPFS payment so usually payers do not pay for the supplies separately. There can be payer-specific policies regarding different supplies. We could not find any specific supply code for application of gel form medicine. In CPT, you cannot use 96372 also since that's applicable for "injections" only.
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We would get back if we come across specific code(s) related to this.

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