J0702 and an NDC not listed in FDA NDC list

[wpj371]

Good morning all,

I don't have that much experience with different J-code scenarios, so I want to throw this one out at you...

A podiatrist is billing 20550 for a tendon sheath injection and J0702 for a betamethasone solution.  All payors have paid it except that UHC has begun to deny stating missing or invalid NDC code or unit of measure. We WERE having issues with the NDC not being transmitted, but I got that fixed and the denials continue. The remarks seem to be indicating more specifically that it is a mismatch now.

I will admit that I haven't called UHC to discuss yet, but I did find that there are only two active NDC codes on the FDA list for this particular solution, and the NDC on the vial is neither of those. This NDC does not show up in any NDC lookups or the list I downloaded from the FDA. Doctor buys it from a compounding pharmacy in Alabama I think, don't know if that really matters at all.

Advice?  Is there any j code we should use that's for an unlisted drug? Do you think I'm on the right track that this NDC code is the issue? Are you gonna make me call UHC first? :-)

Give me all your advice. I need to decide if I should advise the doctor to buy the ones that are actually on the list, or if we can make this work AND get some of these prior claims paid. Doctor is going to be unhappy if he can't use the drug he already bought, so I want to get as much info as I can before I advise him.

Thanks!

[kristin]

It does sound to me like the issue is he is using an "off-label" version of the injectable, therefore UHC won't pay. You could try using the J3490 unlisted drug code, or he can start using one of the two types that do have reportable NDC codes.

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