RFI # 1297: NDC and HCPCS conversions
Informal Formal
Submitter
Gladys Jones |
Description
In the Examples section of the 837 Prof TR3, on page 573 we don't agree.
2400 SERVICE LINE LX*2~ SV1 PROFESSIONAL SERVICE SV1*HC:J0696*682.50*UN*56*12**1~ DTP DATE - SERVICE DATE(S) DTP*472*RD8*20040201-20040207~ DTP DATE – PRESCRIPTION DATE DTP*471*D8*20040130~ 2410 DRUG IDENTIFICATION LIN DRUG IDENTIFICATION LIN**N4*00004196501~ CTP DRUG QUANTITY CTP****7*UN~ REF PRESCRIPTION NUMBER REF*XZ*2530001~ Our Example: The code J0696 is 250 mg per one unit, the NDC code for J0696 is 00004-1965-01 which is 2 gr. per vial which equals to 2000 mg. 250/2000 = 8 . So if one vial is 8 units and we only gave 7 units, it should be a minus not a multiply. We would report 8 units in two lines 7 as what was given and one unit as the discarded drug. Your example: In your example 56 units X 250 mg = 14,000 mg 14,000 mg divide by 2000 grams equals 7 vials of J0696. Based on this 7 vials was given to the patient and not one. Could you please let us know which the correct way to report the NDC is? |
Response
8 units of HCPCS J0696 is equivalent to 1 unit of NDC 00004-1965-01. Therefore, the example correctly depicts this ratio by stating 56 units of J0696 and 7 units of NDC 00004-1965-01 were dispensed. The calculation is 7 vial units times 8 250mg units, which results in 56 250mg units. The qualifier UN does not represent the same unit of measure at the line (SV1) and subline (CTP) levels. Generally, a payer will adjudicate based on the coding at one level or the other. |
Submission | 4/8/2011 |
Status Date | 6/1/2011 |
Status | F - Final |
Primary References | |
Document | 005010X222 |
Section | 2 |
Set ID | 837P |
Table | 2 |
Loop | 2400 |
Segment ID | SV1 |