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5010 and National Drug Codes: Clearing Up a Few Questions

The arrival of the 5010 electronic claims transaction standard has created quite a few questions in regard to the proper use of National Drug Codes (NDCs). Here are the answers to some frequently asked questions.

Question: I’ve heard conflicting requirements regarding NDC reporting—some only want NDCs on “not otherwise specified” codes (e.g., J3490). However, I’ve also heard that NDCs are necessary on every drug. Could you clarify?

Answer: NDCs are not required for every drug. The 5010 specification says NDCs are used: 1) when the government mandates it (e.g., for rebate programs) or 2) when you choose to report them to enhance claim reporting/adjudication. Many times a HCPCS code adequately describes the drug in terms of description, quantity and measurement type. However, for certain non-specific J codes like J3490, including either an NDC or a description likely would result in better claim processing.

Question: When reporting an NDC value, does anything else need to be reported along with the NDC value?

Answer: When you report an NDC, you must report the NDC’s appropriate drug unit amount and also the drug measurement type (e.g., iu, mg, ml, etc.).  Each service line with an NDC should have the CPT/HCPCS code, the NDC, the NDC’s drug unit amount, and the NDC’s drug measurement type code.

Question: Is there a list of which “J” codes require reporting an NDC value and its unit and measurement type values?

Answer: Unfortunately, we’re not aware of a master list of which “J” codes should contain an NDC. However, a good indicator when an NDC might be useful for claim processing is to look for the words “non-classified,” “not otherwise specified,” or “unclassified” in the CPT/HCPCS description. Remember, too, that whenever you report an NDC along with any service (“J” code or otherwise), the NDC is what triggers the requirement that NDC drug units and drug measurement type must be present.

Question: How will we report compound drugs? Will we bill for each drug individually using a separate NDC for each portion of the drug?

Answer: Yes, you report each separate NDC associated with the compound drug on separate service lines (one NDC per service line). The CPT/HCPCS code would repeat as many times as necessary to report the different component NDCs. While not all payers will require it, component drugs reported on each separate service line should be linked together with either a prescription number or a unique number generated by the practice.

Question: What is the Food and Drug Administration (FDA) website address to check NDC codes?

Answer: The FDA’s NDC look-up site is: http://www.fda.gov/Drugs/InformationOnDrugs/ucm142438.htm.