NDC Number Setup and Posting Process

If your practice needs to add National Drug Codes (NDC's) to CGM webPRACTICE to report to insurance carriers, you have two available options. You can use either or both options based on the needs of your practice.

Option 1: You can report the NDC procedure code separately from the injection procedure code if the NDC changes every time.
Option 2: You can store the NDC within the injection procedure code if the NDC always remains the same.

NDC Format
The following information was copied from the FDA Government website. You can also search the National Drug Code Directory.

'Each listed drug product listed is assigned a unique 10-digit, 3-segment number. This number, known as the NDC, identifies the labeler, product, and trade package size. The first segment, the labeler code, is assigned by the FDA. A labeler is any firm that manufactures (including repackers or relabelers), or distributes (under its own name) the drug. The second segment, the product code, identifies a specific strength, dosage form, and formulation for a particular firm. The third segment, the package code, identifies package sizes and types. Both the product and package codes are assigned by the firm. The NDC will be in one of the following configurations: 4-4-2, 5-3-2, or 5-4-1.

An asterisk may appear in either a product code or a package code. It simply acts as a place holder and indicates the configuration of the NDC. Since the NDC is limited to 10 digits, a firm with a 5 digit labeler code must choose between a 3 digit product code and 2 digit package code, or a 4 digit product code and 1 digit package code.

Thus, you have either a 5-4-1 or a 5-3-2 configuration for the three segments of the NDC. Because of a conflict with the HIPAA standard of an 11 digit NDC, many programs will pad the product code or package code segments of the NDC with a leading zero instead of the asterisk.

Since a zero can be a valid digit in the NDC, this can lead to confusion when trying to reconstitute the NDC back to its FDA standard. Example: 12345-0678-09 (11 digits) could be 12345-678-09 or 12345-0678-9 depending on the firm's configuration. By storing the segments as character data and using the * as place holders we eliminate the confusion. In the example, FDA stores the segments as 12345-*678-09 for a 5-3-2 configuration or 12345-0678-*9 for a 5-4-1 configuration.'

To comply with HIPAA and Centers for Medicare and Medicaid Services (CMS) requirements, NDC numbers submitted on claims must be 11 digits. When you obtain the NDC code, either from the actual label on the medication or from the NDC website, you must type a zero (0) in place of the asterisk (*) in the code.

Set up the Procedure Code(s)
Complete the following steps for the applicable option(s) to set up the NDC's.

Option 1: Report the NDC procedure code separately from the injection procedure code.

Create the NDC Procedure Code
1. From Tables, Procedure Code Table, Maintain Procedure Codes:
2. Type 'NDC' in the Procedure Code, Procedure Description, and Brief Description fields.
3. In the Type of Service field, type the code you want or select from Type of Service list.
4. Select Yes for the Bill to Insurance options.

Option 2: Store the NDC within the injection procedure code.

Add the NDC to the injection procedure codes.
1. From Tables, Procedure Code Table, Maintain Procedure Codes:
2. Select an injection procedure code and type the NDC in the NDC Code field in every applicable injection procedure. Type only the NDC, a forward slash '/', and the unit of measure. (Some carriers require a unit of measure code. The NDC Unit of Measure HIPAA Values are F2, GR, ML, or UN.) For example, if the NDC is 00003-1962-01 and the Unit of Measure is F2, you would type 00003196201/F2.

Procedure Entry Requirements for NDC's:

Option 1: Report the NDC procedure code separately from the injection procedure code.

In the Procedure Entry Function, type 'NDC' in the procedure code (Proc) field directly beneath the injection procedure code that it refers to.
Type the NDC in the Description field. Type only the NDC, a forward slash '/', and the unit of measure. (Some carriers require a unit of measure code. The NDC Unit of Measure HIPAA values are F2, GR, ML, or UN.) For example, if the NDC is 00003-1962-01 and the Unit of Measure is F2, type 00003196201/F2. The text you type in the Description field is sent electronically or prints in Box 24 above the injection code with an 'N4' qualifier in front of it.
If you type the NDC procedure code in the Procedure Entry Function it overwrites any NDC number stored in the Procedure Code Table for the injection code.
Type the applicable number in the Multiplier (Mlt) field: For example if the patient is administered one 3mm injection, type '1' in the Mlt field next to the injection procedure code. If three separate injections of the same medication (3mm each) are administered to a patient, type '3' in the Mlt field on the injection code charge.
Note: If you have any questions, contact the insurance carrier for clarification of their specific requirements.

Option 2: Store the NDC within the injection procedure code.

You only need to enter the injection procedure code in the Procedure Entry Function.
Type the applicable number in the Multiplier (Mlt) field: For example if the patient is administered one 3mm injection, type '1' in the Mlt field next to the injection procedure code. If three separate injections of the same medication (3mm each) are administered to a patient, type '3' in the Mlt field on the injection code charge. Note: If you have any questions, contact the insurance carrier for clarification of their specific requirements.
The number stored in the NDC Code field for the injection procedure code is automatically sent electronically or prints in Box 24 above the injection code with an 'N4' qualifier in front of it.