RETIRED - Correct Coding - NOC HCPCS Codes Used for Drugs - JA DME

Article retired due to content incorporation into the applicable Local Coverage Determination or related Policy Article.

DME MAC Joint Publication

Posted December 1, 2016

Correct coding requires an item be coded with the most specific code available that appropriately describes the item.  Not Otherwise Classified (NOC) Healthcare Common Procedure Coding System (HCPCS) codes must only be used when a more specific HCPCS code is not available.  A recent review of NOC codes used with drugs was performed.  The following codes had errors in coding:

• J3490 - Unclassified Drugs
• J7599 - Immunosuppressive Drug, Not Otherwise Classified
• J7699 - NOC Drugs, Inhalation Solution Administered Through DME
• J7799 - NOC Drugs, Other Than Inhalation Drugs Administered Through DME
• J8499 - Prescription Drug, Oral, Non Chemotherapeutic, NOS
• J8597 - Antiemetic Drug, Oral, Not Otherwise Specified
• J8999 - Prescription Drug, Oral, Chemotherapeutic, NOS
• J9999 - Not Otherwise Classified, Antineoplastic Drug

The most common errors were:

• Claims were billed for drugs that have specific HCPCS or NDC codes and should not have been billed to Medicare with the NOC HCPCS code
• Claim line descriptions could not be deciphered to identify a specific item

Details for the individual codes are below.

J3490 - Unclassified Drugs

• Claims were billed for drugs that have specific HCPCS codes and should not have been billed with the NOC HCPCS code.  The most common drugs billed erroneously were (in descending order):
  • Penicillin
  • Heparin
  • Epinephrine
  • Morphine
  • Ceftriaxone
  • Acetaminophen
  • Vancomycin
  • Lidocaine
  • Cefepime
  • Etoposide
  • Ampicillin
  • Cefazolin
  • Meropenem
  • Ringers lactate infusion
  • Albuterol
  • Fluorouracil
• Claim line descriptions could not be deciphered to identify a specific item

J7599 - Immunosuppressive Drug, Not Otherwise Classified

• Claims were billed for drugs that have specific HCPCS codes and should not have been billed with the NOC HCPCS code.  The most common drugs billed erroneously were (in descending order):
  • Astagraf XL® (tacrolimus extended-release capsules).
  • Envarsus XR™ (tacrolimus extended-release tablets).

J7699 - NOC Drugs, Inhalation Solution Administered Through DME

• Claim line descriptions could not be deciphered to identify a specific item

J7799 - NOC Drugs, Other than Inhalation Drugs Administered through DME

• Claims were billed for drugs that have specific HCPCS codes and should not have been billed with the NOC HCPCS code.  The most common drugs billed erroneously were (in descending order):
  • Immune globulin infusion 10% (human) with recombinant human hyaluronidase (hyqvia)
  • Carbidopa and levodopa enteral suspension (duopa)
  • Blinatumomab (blincyto)
• Claim line descriptions could not be deciphered to identify a specific item

J8499 - Prescription Drug, Oral, Non Chemotherapeutic

• Claims were billed for drugs that have specific HCPCS codes and should not have been billed with the NOC HCPCS code.  The most common drugs billed erroneously were (in descending order):
  • Compazine
  • Dexamethasone

J8597 - Antiemetic Drug, Oral, Not Otherwise Specified

• Claim line descriptions could not be deciphered to identify a specific item

J8999 - Prescription Drug Oral, Chemotherapeutic, NOS

• Claims were billed for drugs that have specific HCPCS codes and should not have been billed with the NOC HCPCS code.  Oral anticancer drugs must be billed to Medicare with the applicable NDC code.  The most common drugs billed erroneously were (in descending order):
  • Capecitabine
  • Topotecan (hycamtin)
• Claim line descriptions could not be deciphered to identify a specific item

Suppliers are encouraged to assure that the appropriate specific HCPCS or NDC code is used when billing Medicare for Drugs.  Suppliers are reminded that the units of service for a drug code may not match the available dosage forms.  In these cases, the number of UOS billed must be adjusted to match the actual amount provided.

Suppliers are also encouraged to make sure that entries in the narrative field are legible and, in the case of abbreviations, the original term can be determined from the shortened entry.

Refer to the applicable Local Coverage Determinations and related Policy Articles for additional information.

For questions about correct coding, contact the Pricing, Data Analysis, and Coding (PDAC) contractor 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.  The PDAC website also contains a list of HCPCS codes and descriptors which are located in the DME Coding System (DMECS) at https://www.dmepdac.com/.