Wiki J3490, FB modifier, and NDC

[jorellana42]

Occasionally, we inject patients in office for drugs that were purchased by the patients in their pharmacy. Some of these drugs don't have a corresponding J code, so we are documenting with J3490 on the claim. The issue is that there are different NDCs that correspond with the drugs. If we code J3490 with an FB modifier to show that we are not to be reimbursed for the drug, and bill the administration code (96372), do we have to put an NDC? Can we just put 00000-0000-00 or something like that (not an actual NDC number) on the claim?

 

[thomas7331]

You will still need to add the correct NDC number - this serves to identify the drug to the payer so that they can know whether or not the administration of the drug is a covered benefit under the patient's plan. I believe most payers these days will reject your claim if you submit this with an invalid NDC number.

I'd mention too that I don't this it's standard to use an FB modifier in this situation as that modifier is mainly used for devices that are being replaced and are at no cost because, for example, they are covered by a warranty. It's not commonly used for drugs that are supplied by the patient's pharmacy. Payers may not correctly process your claims unless they have a reimbursement policy the specifically requests this modifier in this situation. The standard practice is to simply bill a zero dollar or $0.01 charge for the drug that your office did not purchase.