Wiki Prority Health rejection of 90471

[bradleybfam3]

I'm finding more and more claims from earlier this year denying for no NDC on administration of injection. Exact denial is:
The billed service, 90471 (IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE), was denied because the National Drug Code (NDC) number is invalid, per our policy, which is based on Food and Drug Administration (FDA) Policy.
• Rationale: According to our policy, which is based on Food and Drug Administration (FDA) Policy, providers are required to report valid National Drug Code (NDC) numbers. The reported NDC number does not exist in the standard NDC reference sources. It's not making any sense to me, what am I missing?

 

[Pam Warren]

Each medication or vaccine that you administer has an National Drug Code. That goes on the claim form to further identify what was administered, but also to track nationally (in case there's an issue with a particular formula). The payer is telling you that national drug code for the medication/immunization you're administering is either missing from your claim form, or it doesn't match what you administered. The code you're reporting is just the administration code. What vaccine CPT code did you use? That's the NDC you'll want to report. If the vaccine is state supplied, you'd still report the CPT and the NCD on the claim, but with a .01 charge and adjust it after claims adjudication.

 

[bradleybfam3]

Each medication or vaccine that you administer has an National Drug Code. That goes on the claim form to further identify what was administered, but also to track nationally (in case there's an issue with a particular formula). The payer is telling you that national drug code for the medication/immunization you're administering is either missing from your claim form, or it doesn't match what you administered. The code you're reporting is just the administration code. What vaccine CPT code did you use? That's the NDC you'll want to report. If the vaccine is state supplied, you'd still report the CPT and the NCD on the claim, but with a .01 charge and adjust it after claims adjudication.

Thank you so much! I've been hearing conflicting information regarding this issue. Researching is the best!