Wiki NDC reporting for multiple vials used

[Lmurphy1978]

We are beginning to see a lot of payer communications surrounding reporting NDC appropriately but depicted billing examples are not given.


Here is the example:

How to report for Commercial vs. Medicare vs. Medicaid:

Example:
i.e. Administered 350mg of Q5123 Riabni 100mg 10mg/ml 10ml SDV -NDC #: 55513-0224-01--> (4 SDV used w/ waste)
Wasted 50mg
+
Administered 500mg of Q5123 Riabni 50mg 10mg/ml 50ml SDV -NDC #: 55513-0326-01 --> (1SDV used, no waste)
--------------------------------
Total: 85 units (850mg) administered w/ 5 (50mg) units waste
--------------------------------
With the above example, would we bill just 2-line items to show total administration, or 3- line items to include both NDCs and waste?

 

[CBLENNIE]

Question was this all done on the same patient on the same DOS? I'm asking because you are asking about billing 2 or 3 lines on the claim and that makes me think it is a single encounter with the same patient.

On as side note, I will tell you as someone who works for an insurance company and did audits, on the first dosing in your example where the patient received 350 mg we would not cover the waste in this scenario. You stated 4 100mg SDVs were used when it would have been more appropriate to use 3 100mg SDVs and 1 50mg SDV which would've resulted in 0 waste. We actually run an audit concept specifically for unnecessary drug waste. If I'm misunderstanding what you are communicating about what was administered to the patient on the DOS please let me know and I apologize in advance if my information regarding the waste not be covered is incorrect for the amount administered and wasted for the patient on the DOS.

 

[Lmurphy1978]

Yes, this example was for the same encounter on same patient. And the nurse pulled the drug this way from the cabinet and then administered.
Would this inquire differ with commercial vs government plans, and Medicaid?

Essentially, this occurs sometimes where two different NDCs are used for same drug for same patient encounter and we need to know how to report both NDCs in those instances for the various payers.

 

[CBLENNIE]

I think you are going need to check with your payers but from my end working for an insurance company, I would say that it should be billed on 2 lines with the number of units of the drug administered listed with each NDC number. That way you are advising the payer we administered X units of NDC 123 and X units of NDC 456 and the total number of units between the 2 lines should be the total billed.

 

[Lmurphy1978]

I think you are going need to check with your payers but from my end working for an insurance company, I would say that it should be billed on 2 lines with the number of units of the drug administered listed with each NDC number. That way you are advising the payer we administered X units of NDC 123 and X units of NDC 456 and the total number of units between the 2 lines should be the total billed.

Thank you.