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J9190

  1. #1
    Default J9190
    Exam Training Packages
    Is anyone out there having an issue getting this drug to pay. The problem I am finding is Georgia Medicaid doesn't want to pay the drug with the NDC code I am using. The NDC code is directly off the medication bottle from the manufacture. Any ideas? I am relatively new to Hem/onc billing and coding

    thanks

  2. #2
    Location
    Columbia, MO
    Posts
    12,557
    Default
    Are you using the N4 qualifier with no space before the NDC number? Is the number going into the shaded space abover the J9190 and not box 19?

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Default
    yes, and i have double checked the NDC code. I have even hand keyed it on the denied claim and tried to resubmit it. It is very frustrating.

  4. #4
    Location
    Columbia, MO
    Posts
    12,557
    Default
    the only other thing I can think of then is are there 11 digits in you NDC # (13 characters total with the N4 qualifier added)? and again just double check where your software is putting the number and be sure it is not box 19.

    Debra A. Mitchell, MSPH, CPC-H

  5. Default
    We are having the same problem with our local Medicaid. The problem is that they do not have all the possible NDCs loaded in their claim computer. We have been told it will take 6 months to add them. In the meantime we have to appeal to our state HHSC.

  6. #6
    Default
    We have discovered that more often than not the NDC# on the bottle/vial would be different if you compare it to the NDC# on the box the bottles/vial come in. NC Medicaid might deny a reimbursement on the drug with the NDC# off the vial but would have no problem reimbursing when we re-file the drug with the NDC# indicated on the bottle.

    Best regards-

  7. #7
    Default
    I meant to say "when we re-file the drug with the NDC # indicated on the box" lp
    Lioubov Petrova, CPC, CHONC, CEMC, CPMA

  8. #8
    Location
    Bettendorf, Iowa
    Posts
    133
    Default
    Our medicaid carrier uses an electronic NDC directory and usually if we have problems I find that our NDC is no longer on the list.

    http://www.accessdata.fda.gov/script...dc/default.cfm
    Ruth Long CPC,CHONC
    relong@rccqc.com

  9. #9
    Default
    thank you for the web link. Coming from a radiology background learning NDC and billing procedures for Hem/Onc has been different.

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