Wiki "Not Otherwise Specified" Chemo Drugs

[Anspachemily@gmail.com]

Hi everyone! I am having the hardest time with billing a handful of drug codes that are labeled "not otherwise specified" and they are all rejecting straight out the door. I've tried to add the descriptions necessary to note and narrative lines, but nothing I've tried has been successful, so I was hoping someone here would have experience with these codes.

The following are codes with this issue I've ran into:
J0612 - Injection, calcium gluconate, not otherwise specified, 10 mg
J9201 - Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg
J9075- Injection, cyclophosphamide, not otherwise specified, 5 mg

I'm referencing this article to make the notes: https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00166304

So far, I've tried including the dosage, amount administered/wasted, manufacturer, and drug name in the note/narrative, and of course always have the NDC on the claim. For example, for J9075 my note would look like "CYCLOPHOSPHAMIDE BLUEPOINT LABORATORIES 1545MG INTRAVENOUS 455 MG WASTE". What could I be missing? Has anyone else dealt with this?

Thanks in advance!!

 

[ahrx13]

That all seems like the correct thing to do when dealing with NOS codes, would you mind sharing the denial code/reason?

 

[rachaelwilleford]

Hi everyone! I am having the hardest time with billing a handful of drug codes that are labeled "not otherwise specified" and they are all rejecting straight out the door. I've tried to add the descriptions necessary to note and narrative lines, but nothing I've tried has been successful, so I was hoping someone here would have experience with these codes.

The following are codes with this issue I've ran into:
J0612 - Injection, calcium gluconate, not otherwise specified, 10 mg
J9201 - Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg
J9075- Injection, cyclophosphamide, not otherwise specified, 5 mg

I'm referencing this article to make the notes: https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00166304

So far, I've tried including the dosage, amount administered/wasted, manufacturer, and drug name in the note/narrative, and of course always have the NDC on the claim. For example, for J9075 my note would look like "CYCLOPHOSPHAMIDE BLUEPOINT LABORATORIES 1545MG INTRAVENOUS 455 MG WASTE". What could I be missing? Has anyone else dealt with this?

Thanks in advance!!

These are not otherwise specified, meaning there isn't another code that covers this drug (the other codes have specified manufacturers). The NOS drugs are not the same as not otherwise classified (NOC) drugs. You still bill them with appropriate units, modifiers, etc. How many mg/units are you billing for each?

For example, J9075 you would bill one line of 309 units with JZ modifier and another line with 91 units with JW modifier.