Wiki Quietha R.

[QUIETHA]

We gave a blue cross patient 60 mg Doxil (Q2050) which would actually be 6 units per 10 mg according to AMA but we continuously get paid for only one unit and denied for other because blue cross considers metric units instead of mg and states we need to show 30 units on claim. Has anyone come across this issues and can someone give me recommendations on what to do. We are going by AMA guidelines which has code Q2050 as per 10mg. Help please!!!
Quietha R.

 

[OncologyOKC]

I'm not sure what region you are in but I can tell you that in Oklahoma BCBS requires all NDC information to be provided with either ML or Units on the descriptor.

You follow CMS billing guidelines as far as how many units of Q2050 to bill but when providing the NDC# you will need to convert to either ML or Units based on how the vial is dispensed.

This is very confusing to try to explain but maybe this will help. When billing Aloxi (J2469) 250mcg you will bill J2469 X 10, however when you provide the NDC# 62856079701 5ml is the description to use.

check with your local BCBS provider. In Oklahoma BCBS provides a conversion website you plug the NDC# into to get the ML/Unit conversion.