CORRECT CODING – ORAL ANTICANCER DRUGS AND PDAC’S NDC/HCPCS CROSSWALK LISTINGS


DME MAC Joint Publication

Occasionally pharmaceutical manufacturers release drugs with NDCs and they do not immediately appear on the NDC/HCPCS crosswalk list maintained by the Pricing, Data Analysis and Coding (PDAC) contractor (see article from April 2013 entitled “Oral Anticancer Drugs – Coding and Billing Change”). This recently happened when Roxane Laboratories, Inc., a manufacturer of oral cyclophosphamide, discontinued their tablet forms of the drug and substituted capsules. Initially the capsule forms of the drug (NDC 00054-0382-25 for the 25 mg strength and NDC 00054-0383-25 for the 50 mg strength) were not on the NDC/HCPCS crosswalk list. This list has now been updated to reflect the new dosage forms and NDC numbers for Roxane’s cyclophosphamide.

If a supplier bills an oral anticancer drug with an NDC number that is not on the NDC/HCPCS crosswalk list, the claim will receive a front-end reject by CEDI. To avoid this situation, suppliers should follow the instructions in the Coding Guidelines section of the Oral Anticancer Drugs related Policy Article (PA) which states:

A list of valid NDC numbers called the “NDC/HCPCS Crosswalk” for covered oral anticancer drugs can be found on the Pricing, Data Analysis and Coding (PDAC) Contractor web site. Until a new NDC number is added to the list, suppliers must submit claims using code J8999.

Until a new NDC number is added to the list in the monthly update, suppliers have two options:

  1. Hold claim submission until the NDC/HCPCS Crosswalk reflects the monthly update of covered OACDs; or,
  2. Submit claims using code J8999.

Claims submitted using code J8999 must include the name of the drug, the manufacturer, the NDC number, the dosage strength of each drug form (e.g., capsule, tablet, suppository, liquid) and the number of tablets or capsules dispensed. This information must be entered in the narrative field of an electronic claim (NTE 2300 or NTE 2400 of an electronic claim) or Item 19 of a paper claim.

The NDC/HCPCS Crosswalk files can be found on the PDAC Web site at
https://www.dmepdac.com/crosswalk/index.html

For questions about correct coding, contact the PDAC Contact Center at (877) 735-1326 during the hours of 8:30 a.m. to 4:00 p.m. CT, Monday through Friday, or e-mail the PDAC by completing the DME PDAC Contact Form.

 

Published by Noridian as the PDAC, November 2014. Republished by Palmetto GBA as the PDAC, February 2019.  Please note that links in this document were accurate at the time of original publication and may change over time and are no longer active.



Last Updated: 11/13/2014