Wiki Duplicate NDC denials

[lcole7465]

Hello - I just recently starting coding for Rheumatology. We have a drug - Acterma; CPT J3262 that we bill with 2 different NDC #'s and units. An example is: we use 600 units and bill as 1 line with 400 units with appropriate NDC # and the 2nd line would be billed with 200 units with the appropriate NDC #. The insurances will deny 1 line as a duplicate NDC and then we have to appeal the claim. Does anyone have any suggestions on the coding to possibly avoid the duplicate NDC denials.

This happens with multiple insurance across the board, not just one insurance in particular.

Thank you in advance for any help

 

[SharonCollachi]

You're getting duplicate NDC codes but using two different NDC codes?

 

[lcole7465]

Yes, they are 2 different doses with different NDC codes and the insurance is denying one as a duplicate.

 

[fwnewbie]

I think I'd call that insurance and find someone who could specify how they want it done.

 

[SharonCollachi]

I think I'd call that insurance and find someone who could specify how they want it done.

Someone else here asked recently how to code one drug with two different NDC numbers, and I found a link for that. If you've done it that way and they're denying, I agree with fwnewbie, I would definitely call and ask them to tell me how two different NDC codes are the same.

 

[mwinkwalk11@gmail.com]

Not sure if you've resolved this issue, but what I have done with antibiotic infusions that require 2 separate vials of the same drug and have 2 different NDC #'s I use 1 NDC # (from the larger vial/dosage) and adjust the unit of measure to fit with the dosage given and my claims are being paid. Ie: we use Daptomycin in 500mg and 350mg vials...if we give an 850mg dose I change the unit of measure to 1.7 (units). Hope this helps!