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Back  RFI # 1297: NDC and HCPCS conversions

Formal vs. Informal Help 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
Section2
Set ID837P
Table2
Loop2400
Segment IDSV1