Page 35 - Layout 1

SAN ANTONIO
MEDICINE

Check Claims Dates for Drug

Administration as Coding Updates Loom

By Alisa Pierce

With annual updates to billing codes for medications set for January in identifying those relationships between NDCs and HCPCS codes.
1st, physicians are reminded to use the most current National Drug However, Texas Medical Association experts caution practices to
Code (NDC) and Healthcare Common Procedure Coding System make sure the NDC used is valid for the date of service. The effective
(HCPCS) combinations when filing claims for drug administration. date of the NDC must correlate with the date of service used on the
Each drug product is identified by a universal NDC and assigned claim. This is because NDCs can expire, change, or be prematurely re-
an HCPCS billing code from databases that publish each year on Jan- moved from the national database. For instance, for a prescription ad-
uary 1st. ministered prior to the Jan. 1 publication, use the prior NDC number.
Physicians can utilize resources like the NDC-to-HCPCS Crosswalk, To ensure correct payment, the NDC code on the claim must corre-
which is available for clinician-administered drug processing. The Texas spond to that on the medication vial.
Health and Human Services Commission (HHSC) publishes the cross- If you are receiving claims denials, contact TMA’s payment specialists
walk, based on additions to the Centers for Medicare & Medicaid Serv- for help.
ices’ list of rebate-eligible drugs and new drugs. Clinicians can check
the site each month for updates and are encouraged to reference the na- Alisa Pierce is a reporter for Texas Medicine, Division of
tional database of NDC and HCPCS codes in the meantime. Communications and Marketing.
When billing for administration of a drug, physicians must pull from
the vial a specific NDC number that correlates with the payable Copyright Texas Medical Association. Reprinted with permission
HCPCS code in the national database. The crosswalk aids physicians from TMA Publications.

Visit us at www.bcms.org 35