Guide to coding for buy-and-bill drugs
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Under the buy-and-bill model, HCPs are responsible for billing and coding to ensure reimbursement
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Specialty pharmacies are generally responsible for billing and coding when they have acquired the drug, and may also conduct BIs in addition to HCP verifications
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Accurate coding in claims is essential to ensure timely reimbursement by payers
This is an overview of the types of codes that may be familiar to most HCPs:
Code
Type
Description
ICD-10-CM1
Diagnosis
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International Classification of Diseases, 10th revision
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Coding for all diseases, disorders, injuries, infections, and symptoms
NDC2
Drug
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National Drug Code
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A unique 10- or 11-digit, 3-part number used as a universal product identifier for drugs in the US
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The first 4 or 5 digits identify the labeler (eg, manufacturer), followed by the product (3 or 4 digits) and package (1 or 2 digits) codes
HCPCS3
Procedure
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Healthcare Common Procedure Coding System
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Used for drugs, supplies, services, and equipment (eg, C-codes and J-codes)
CPT3
Procedure
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Current Procedural Terminology
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Reports medical services and procedures provided by HCPs
Revenue codes4
Payment
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Indicates the cost center for an individual service on an institutional/facility claim
Code
Type
Description
ICD-10-CM1
Diagnosis
-
International Classification of Diseases, 10th revision
-
Coding for all diseases, disorders, injuries, infections, and symptoms
NDC2
Drug
-
National Drug Code
-
A unique 10- or 11-digit, 3-part number used as a universal product identifier for drugs in the US
-
The first 4 or 5 digits identify the labeler (eg, manufacturer), followed by the product (3 or 4 digits) and package (1 or 2 digits) codes
HCPCS3
Procedure
-
Healthcare Common Procedure Coding System
-
Used for drugs, supplies, services, and equipment (eg, C-codes and J-codes)
CPT3
Procedure
-
Current Procedural Terminology
-
Reports medical services and procedures provided by HCPs
Revenue codes4
Payment
-
Indicates the cost center for an individual service on an institutional/
facility claim
Codes are subject to change. Verify current coding prior to any claim submission.
THIS INFORMATION IS PROVIDED FOR EDUCATIONAL PURPOSES ONLY AND IS NOT A GUARANTEE OF COVERAGE. IT IS THE SOLE RESPONSIBILITY OF THE HEALTH CARE PROVIDER TO SELECT THE PROPER CODES AND ENSURE THE ACCURACY OF ALL STATEMENTS USED IN SEEKING COVERAGE AND REIMBURSEMENT FOR AN INDIVIDUAL PATIENT.
References: 1.
Torrey T. Accessed June 23, 2020. https://www.verywellhealth.com/finding-icd-codes-2615311
2. American Academy of Pediatrics. Accessed June 23, 2020.
https://www.aappublications.org/news/aapnewsmag/2016/04/21/Coding042116.full.pdf
3. Medical Billing & Coding Certification. Accessed June 23, 2020.
https://www.medicalbillingandcoding.org
4. Value Healthcare Services. Accessed October 20, 2020.
https://valuehealthcareservices.com/education/understanding-hospital-revenue-codes