In the February issue of Blue Review, we published an article about billing unclassified drugs/injections under "Not Otherwise Classified (NOC)" drug/injection codes (e.g., J3490, J3590, etc.) using the National Drug Code (NDC) number.
We advised providers that effective February 1, 2009, we would begin checking NDC numbers against the Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPSC) procedure codes as published by the American Medical Association (AMA).
In order to properly adjudicate claims and reimburse providers for these procedure codes, BCBSNM continues to enhance its capabilities for NDC processing to reduce underpayments and overpayments to our providers. We are currently using average wholesale pricing supplied by Prime Therapeutics to properly adjudicate unclassified drugs/injections.
It is important that providers supply the necessary information for BCBSNM to properly adjudicate and reimburse claims for these procedures. Our claims processing units may have called your office requesting additional information about these unclassified drugs/injections when billed by your practice. We have done this to properly adjudicate the claim without having to request additional information in writing, which could delay claim processing.
To minimize these calls to your office, please be sure to include the following information on your claims when billing for unlisted drugs/injections:
- NDC number
- Drug name
- Dosage administered (e.g., 5 mg, 10 mg, etc.)
- How the number of units being billed on the claim are being administered (e.g., 5 mg = 1 unit, 10 mg = 5 units, etc.)
- Strength of drug administered (e.g., 25 mg/ml, 10 mg/10 ml, etc.)
- Single- or multi-dose vial
Note: An NDC number can only be used for a maximum of two years, after which time it becomes obsolete.
If you have questions, contact Provider Customer Service at (888) 349-3706.
